Credentialing Specialist - Provider Data & Compliance

Highmark Health; Charleston (WV); On-site; USD 29,000 - 41,000; Full time

Job summary

Highmark Health in Charleston, WV is seeking a Credentialing Specialist to process provider applications and re-applications, maintain provider data, and communicate with providers regarding credentialing status. You will perform credentialing, re-credentialing, and related activities, while coordinating verifications and supporting system implementations with a focus on group practices.

Responsibilities include training credentialing staff, generating monthly reports, and handling complex

Qualifications

• High School Diploma or GED required.
• 3-5 years of related, progressive experience.
• Experience in Provider Data Management, Customer Services or Claims.
• Microsoft Office experience (Word, Excel, PowerPoint, etc.)

Responsibilities

• Credentials and re-credential providers.
• Contact providers or representatives by telephone or in writing to obtain additional information while processing their enrollment applications.
• Screen incoming applications and paperwork for completeness and accuracy and sends necessary paperwork to credentialing vendor.
• When necessary performs credentialing verifications and loads provider to appropriate networks and credentialing information to the provider database.
• Manage credentialing inventory, reports and projects to ensure all established time frames for completing work, reports and projects are met.
• Depending on level, train credentialing team in the use of various systems, software, databases, processes and procedures.
• Create and distribute monthly reports as assigned and handle complex and unusual or high-level credentialing issues.
• Support projects, audits, business partners, internal departments and external clients.
• Represent department as the Subject Matter expert.
• Pull and research necessary documentation for audits
• Support updates necessitated by our business partners, internal departments and external clients.

Skills

Good written and verbal communication

Provider data management

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Highmark Health in Charleston, WV is seeking a Credentialing Specialist to process provider applications and re-applications, maintain provider data, and communicate with providers regarding credentialing status. You will perform credentialing, re-credentialing, and related activities, while coordinating verifications and supporting system implementations with a focus on group practices.

Responsibilities include training credentialing staff, generating monthly reports, and handling complex