Credentialing Specialist
Credentialing Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
At NationsBenefits we are committed to helping health plan members achieve a better quality of life through supplemental benefit solutions. We are also passionate about supporting the goals of our associates and helping them do their best work. Together we can make a meaningful and measurable difference in the lives of millions. Thats something we can all be proud of.
It all begins with how we care about the people we serve. Since 2015 our mission has guided our principles toward delivering solutions for a rapidly changing industry. Compassionate Care is at the center of all we do and it unites us to foster an environment where everyone is empowered inspired and equipped for success.
We offer a fulfilling work environment that attracts top talent and encourages all associates to do their part in delivering premier service to internal and external customers alike. Its how were transforming the healthcare industry for the better. We provide career advancement opportunities within the organization with multiple locations in Florida California Pennsylvania Tennessee Texas Utah and India.
You might also like to know that NationsBenefits is also recognized as one of the fastestgrowing companies in America. Were proud of how far weve come and a career with us also gives you growth opportunities.
Role:
Individuals in the Credentialing Specialist role will be responsible for overseeing the credentialing and recredentialing 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. This role also necessitates strong organizational skills attention to detail and ability to multitask. Basic to intermediate knowledge of Excel is required.
- 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
Education & Qualifications:
- Bachelors or Associates Degree desired
- Healthcare credentialing experience or
- Experience with a managed care organization or
- Experience with provider relations or
- Experience in a related healthcare field
- Understanding of managed care preferred
- Familiarity with NCQA credentialing processes preferred
- Basic to intermediate knowledge of Microsoft Applications
- Quick learner and selfmotivated
- Work as a team member or independently
- Strong problemsolving skills
- Professional presentation and demeanor
- Outstanding organization skills
Required Experience:
Unclear Seniority
Employment Type
Full-Time
