Credentialing Specialist (27787300)

Moda Partners, Inc.; Oregon; Hybrid; USD 27,000 - 30,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401K matching

FSA

EAP

PTO and holidays

Job summary

Moda Health in Oregon seeks a Credentialing Verifier to perform credentialing and re-credentialing for contracted providers in compliance with NCQA and state/federal standards.

This is a full-time position offering remote or hybrid work options, with pay range $19.43–$21.86 per hour depending on qualifications. Applicants should have strong organizational skills and familiarity with credentialing standards.

Qualifications

• Typing speed of at least 50 words per minute and Ten key proficiency (135 kspm) is required.
• Strong organizational and time management abilities with attention to deadlines.
• Ability to handle confidential information and work independently or in a team.
• Knowledge of NCQA, CMS and Oregon credentialing standards is helpful.
• Excellent verbal and written communication and strong interpersonal skills.
• Maintain professional appearance in all interactions.

Responsibilities

• Verify credentials timely and accurately from approved sources on the Moda panel.
• Monitor requests for credentialing and re-credentialing applications.
• Complete documentation and data entry into the credentialing database.
• Identify and report non-compliance or credentialing issues to the supervisor.
• Communicate with providers or staff about status and required documents.
• Update provider demographics in the database.
• Manage provider data within delegated credentialing systems.
• Maintain confidentiality of documents and data; handle all items securely.
• Perform other duties as assigned.

Skills

Typing 50 wpm

Ten key 135 kspm

Organizational skills

Time management

Deadlines & confidentiality

Problem solving

NCQA / CMS / Oregon credentialing know

Verbal & written communication

Interpersonal skills

Professional appearance & demeanor

Job description

Let's do great things, together!

About Moda Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we're focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let's be better together.

Job Summary

Performs all verification activities associated with credentialing and re-credentialing Moda contracted providers in accordance with Moda policies, National Committee for Quality Assurance (NCQA) standards and state and federal requirements. This is a FT WFH position.

Pay Range

$19.43 - $21.86 hourly, DOE.

*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education

1. Type a minimum of 50 wpm on computer keyboard and Ten key proficiency of 135 kspm net.
2. Strong organizational and time management skills.
3. Ability to meet deadlines, maintain confidentiality, produce work high volumes, work independently as well as in a diverse team environment.
4. Ability to problem solve, retain information and have strong attention to detail.
5. Working knowledge of NCQA, the Centers for Medicare and Medicaid Services and Oregon Health Authority or other state credentialing standards helpful.
6. Excellent verbal, written and interpersonal skills.
7. Maintain a professional appearance and demeanor in all internal and external interactions.

Primary Functions

1. Verifies the credentials timely and accurately, through approved sources of providers on the Moda panel.
2. Monitors requests for and receipt of credentialing and re-credentialing applications.
3. Completes all documentation and data entry information into the credentialing database.
4. Identifies and reports any non-compliance or credentialing issues to the credentialing supervisor.
5. Communicates with providers directly or with appropriate office staff regarding the Moda credentialing process, submitted application status and required documentation requests.
6. Updates database with current provider demographics.
7. Manages provider data within the credentialing database from delegated entities.
8. Assures confidentiality of documents, records and data information. Keeps all documents secure and confidential.
9. Performs other duties as assigned.

Contact with others & Working Conditions

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
• Internally with all departments. Externally with vendors, providers, health professionals and physician offices, IPA, Delegates, Rented Networks, Hospitals and Licensing boards.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.

For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via [e-mail] email.