Credentialing Specialist - Healthcare / Medical

NationsBenefits India; Plantation (FL); Hybrid; USD 45,000 - 65,000; Full time

Job summary

NationsBenefits India is seeking a Credentialing Specialist to oversee the credentialing and re-credentialing of providers within NationsBenefits networks. You will work directly with hearing and vision care providers and partner with Provider Support and Hearing/Vision operations to ensure accuracy and timely processing.

The role requires strong organizational skills, excellent communication, and the ability to multi-task.

Qualifications

• Bachelor's or Associate's Degree is desired.
• Healthcare credentialing experience preferred or experience with managed care organizations.
• Basic to intermediate knowledge of Microsoft Applications (Excel, Word, Outlook).

Responsibilities

• Oversee credentialing and re-credentialing of providers in NationsBenefits networks.
• Communicate with hearing and vision care providers and collaborate with Provider Support and Operations teams.
• Manage provider data, follow up via calls and email, and track credentialing documents.

Skills

Interpersonal skills

Organizational skills

Attention to detail

Multi-tasking

Education

Bachelor's or Associate's Degree

Tools

Microsoft Excel

Job description

Individuals in the Credentialing Specialist role will be responsible for overseeing the credentialing and re-credentialing of providers that participate in the various NationsBenefits provider networks. This individual will communicate directly with hearing and vision care providers and work collaboratively with the Provider Support, Hearing, and Vision operations teams. This role requires excellent interpersonal skills to communicate effectively. They must be a positive, energetic individual with strong organizational skills, attention to detail and ability to multi-task. Basic to intermediate knowledge of Excel is required.

Tasks and Responsibilities:

• Maintain records for individual rendering Providers who have been credentialed and/or have applied for credentialing.
• Process, record, and track Provider Credentialing documents and data in processing systems.
• Effectively manage follow up calls and email.
• Monitor faxes, files and other sources of incoming Provider data notifications to ensure that Provider credentialing data is processed in a timely manner.
• Communicate with providers to obtain updated documents as needed during and after credentialing process.
• Maintain and properly store both electronic and hard copies of credentialing files.
• Update provider records and review for completeness and accuracy.
• Synthesize and report on data related to credentialing status and attainment.
• Draft, send, track and update Provider credentialing approval letters.
• Review Provider applications prior to Credentialing Committee meetings to identify possible issues in applications.
• Coordinate with Network Accuracy Specialist to reconcile gaps in information on providers between our system and the Credentialing Report.
• Take minutes at monthly Credentialing Committee meetings and distribute them for record keeping and approval.
• Serve as a liaison with Credentialing Verification Organizations
• Other duties and special projects may be assigned based on business demands

Qualifications:

Desired Education

• Bachelor's or Associate's Degree desired

Preferred Experience

• Healthcare credentialing experience or
• Experience with a managed care organization or
• Experience with provider relations or
• Experience in a related healthcare field

Knowledge, Skills and Abilities

• Understanding of managed care preferred
• Familiarity with NCQA credentialing processes preferred
• Basic to intermediate knowledge of Microsoft Applications
• Quick learner and self-motivated
• Ability to work as a team member or independently