Assoc Specialist, Corp Credentialing - Remote

Lensa; Tacoma (WA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking an Associate Specialist for Credentialing. This role involves evaluating applications, ensuring compliance with regulatory standards, and maintaining provider confidentiality. Ideal candidates will have strong communication skills and experience in administrative roles. Join a dynamic team dedicated to maximizing safety for members while meeting production goals.

Qualifications

• Experience in a production or administrative role requiring self-direction.
• Extensive experience using a computer and internet research.

Responsibilities

• Evaluates credentialing applications for accuracy and completeness.
• Communicates with healthcare providers to clarify questions.
• Reviews daily alerts for sanctions and exclusions.

Skills

Critical Thinking

Communication

Education

High School Diploma or GED

Tools

Microsoft Outlook

Microsoft Word

Job description

Assoc Specialist, Corp Credentialing - Remote

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

Job Summary

Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing, and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information.

Job Duties

• Evaluates credentialing applications for accuracy and completeness based on provider specialty differences and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals.
• Communicates with healthcare providers to clarify questions and request missing information.
• Updates credentialing software systems with required information.
• Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals.
• Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants.
• Completes data corrections in the credentialing database necessary for processing recredentialing applications.
• Reviews claims payment systems to determine provider status, as necessary.
• Completes follow-up for provider files on ‘watch’ status, as necessary, following department guidelines and production goals.
• Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions.
• Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare.
• Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found.

Job Qualifications

Required Education: High School Diploma or GED.

Required Experience/Knowledge Skills & Abilities:

• Experience in a production or administrative role requiring self-direction and critical thinking.
• Extensive experience using a computer—specifically internet research, Microsoft Outlook and Word, and other software systems.
• Experience with professional written and verbal communication.

Preferred Experience: Experience in the healthcare industry.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.16 - $34.88 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Other

Industries

• IT Services and IT Consulting