CREDENTIALING ASSOCIATE 1

Job Summary:

With assistance and oversight from senior team members, the Credentialing Associate I is responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Works with Credentialing Specialist I to ensure interpretation and compliance with the appropriate accrediting while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database systems and related applications.

Responsibilities:

• Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position.
• Gathers credentials and re-credentialing materials for contracted providers.
• Review and analyze practitioner applications and reapplications, and accompanying documents, ensuring practitioner eligibility.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Prepares credentials file for completion and presentation.
• Responds to inquiries from other healthcare organizations.
• Assists with managed care delegated credentialing audits; conducts internal file audits.
• Monitors the initial process for all Medical/Professional staff and delegated providers. Ensure compliance with rules, regulations, policies, procedures, and delegated contracts.
• Performs related duties consistent with the scope and intent of the position.
• Regular attendance.
• Travel as required

Other Functions

• Enforces Company policies and safety procedures.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
• Maintain IPA, Health Plan compliance standards.

Competencies

• Two years of experience in the medical administration industry.
• High Volume Data Entry Experience required.
• Credentialing and Medi-Cal experience preferred.
• IntelliSoft system experience preferred.
• Excellent communication skills, including both oral and written.
• Excellent active listening and critical thinking skills.
• Ability to solve mid-level problems with minimal supervision.
• Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers.
• Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
• Ability to provide and receive constructive job and/or industry related feedback.
• Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
• Ability to consistently deliver excellent customer service.
• Excellent attention to detail and ability to document information accurately.
• Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
• Demonstrate commitment to the organization’s mission.
• Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint, Outlook).
• Must have the ability to quickly learn and use new software tools.
• Must have mid-level skills using e-mail applications.
• Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
• Ability to work independently as well as in a team environment.
• Ability to present self in a professional manner and represent the Company image.

Education and Licensure

• High School Diploma or GED minimum requirement.
• Associates degree in related field preferred.