Remote Credentialing Specialist – Healthcare Network

American Health Plans; Franklin (TN); Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision

Generous paid time-off

TeleDoc 24/7/365 access to doctors

Supplemental disability plans

Employee Assistance Plan

401K retirement with company match

Employee Referral Bonus Program

Job summary

American Health Plans, a Franklin, TN based division, seeks a Credentialing Specialist to ensure contracted providers meet qualifications and to support reporting to agencies and management. This role collaborates across departments and assists with data analytics.

The position requires maintaining provider demographics, loading data from contracts and rosters, and supporting Credentialing Committee notifications. Remote work is typical with standard hours and occasional travel as needed.

Qualifications

• Must be fluent with provider types, affiliations and relationships.
• Able to work independently and meet goals.
• Excellent data entry and accuracy in records.

Responsibilities

• Maintain and load provider demographic information from contracts and rosters.
• Keep current on all information received; remain within departmental standards.
• Extract and report data for analyses.
• Help maintain database integrity and quality assurance.
• Contact providers in a timely manner to obtain missing and/or incorrect documentation; follow up as necessary.
• Participate on calls with network services staff to assist with troubleshooting; recommend enhancements to related programs.
• Assist with the facilitation of the Credentialing Committee approval and denial notification process (i.e. welcome and denial letters).
• Complete corporate assignments as assigned.
• Other duties as assigned.

Skills

Independent worker

Attention to detail

Effective communicator

Data entry accuracy

Education

High School diploma or equivalent

Post-secondary education preferred

Job description

American Health Plans, a Franklin, TN based division, seeks a Credentialing Specialist to ensure contracted providers meet qualifications and to support reporting to agencies and management. This role collaborates across departments and assists with data analytics.

The position requires maintaining provider demographics, loading data from contracts and rosters, and supporting Credentialing Committee notifications. Remote work is typical with standard hours and occasional travel as needed.