Credentialing Assistant

Visa Hunt; United States; On-site; USD 29,000 - 35,000; Full time

Job summary

CareOregon is seeking a Credentialing Assistant to provide high quality support for credentialing functions within the health plan. You will help with records management, document handling, and customer service, collaborating with the Credentialing Specialist and Supervisor to ensure applications and notifications meet regulatory guidelines.

This role focuses on maintaining confidential records, entering provider information, and supporting audits and reports.

Qualifications

• Minimum 1 year experience in health plan credentialing, medical office, high-production word processing, or work requiring regular use of databases such as Access.
• Familiarity with SharePoint and medical terminology is preferred.
• Strong knowledge of quality assurance and/or compliance is beneficial.

Responsibilities

• Maintain records according to protocol.
• Keep records retrievable to support regulatory requirements.
• Retrieve records for reviews and audits.
• Coordinate and communicate with records management.
• Maintain confidential and time-sensitive material.
• Review credentialing applications and verify requirements to start the process.
• Enter provider information in databases ensuring accuracy.
• Communicate with other departments to align with workflows.
• Communicate with providers about applications by phone and written correspondence.
• Maintain records of applications and credentialing approvals.
• Conduct quality audits of credentialing files.
• Run reports to support the Credentialing team.
• Assist in verification with external sources (e.g., Oregon Board of Medical Examiners).
• Assist in audit preparation for internal/external entities.
• Perform annual and ongoing document reviews.
• Create job aids as needed.

Skills

Records management

Regulatory compliance

Data entry

Customer service

Confidentiality

Audit support

Documentation

Access

SharePoint

Tools

Access

SharePoint

Job description

Credentialing AssistantThis position provides high quality support for credentialing functions within the health plan. Core responsibilities include records management, document management, and customer service as defined in CareOregon credentialing policies and procedures. This position works closely with the Credentialing Specialist and Credentialing Supervisor in the credentialing process to ensure all applications, primary source documentation, and notifications meet regulatory guidelines.

Estimated Hiring Range:

$20.89 - $25.54

Bonus Target:

Bonus - SIP Target, 5% Annual

Essential Responsibilities

• Maintain records according to protocol.
• Keep records in a retrievable manner to support regulatory requirements.
• Retrieve records as needed for activities such as document reviews and audits.
• Coordinate and communicate with records management.
• Maintain confidential and time sensitive material.
• Review provider credentialing applications upon receipt and verify requirements are met to start the credentialing process.
• Enter provider information in databases, maintaining accuracy and completeness of provider information.
• Communicate routinely with other departments to ensure records are being processed according to workflows.
• Communicate with providers regarding applications by telephone and in writing.
• Maintain records of applications and credentialing approval letters.
• Maintain a detailed and confidential credentialing system.
• Conduct quality audits of credentialing files.
• Run required reports to support Credentialing team.
• Assist in the verification of healthcare professional’s information with external verification sources, such as Oregon Board of Medical Examiners and other sources as needed.
• Assist Credential Specialists in meeting team goals and deadlines.
• Assist in audit prep for external and internal entities.
• Perform annual and ongoing document reviews.
• Create job aids as needed.

Experience and/or Education

Required

• Minimum 1 year experience in any of the following: Health plan credentialing, medical office, high-production word processing, and/ or work requiring regular use of Access or other databases

Preferred

• Experience with SharePoint and knowledge of medical terminology

Knowledge, Skills and Abilities Required

Knowledge

• Basic knowledge of quality assurance and/or compliance
• Knowledge of or ability to learn the provider credentialing process
• Knowledge of or ability to learn document management systems

Skills and Abilities

• Ability to retain and maintain confidential files
• Strong organizational skills
• Competency with word processing
• Competency with spreadsheet and database management
• Demonstrated personal initiative and good judgement
• Ability to write and communicate verbally effectively
• Ability to work autonomously
• Ability to perform strong attention to detail to ensure accuracy
• Ability to manage multiple tasks
• Ability to work in a confidential manner with Provider information
• Ability to work as a member of a team in a collaborative manner
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

We are an equal opportunity employer

CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

Originally posted on Himalayas