Job Description: Pay Range: $19.13hr - $24.13hr Responsibilities:
- Supports the overall provider credentialing and re-credentialing processes while maintaining standard turn-around times.
- Responsible to ensure the credentialing files and re-credentialing files are started on time and continue in the process according to standards.
- Monitors participating provider network for credentialing/re-credentialing deficiencies and takes necessary action per the policies and procedures.
- Terminates providers who do not comply with the credentialing standards.
- Prepares and executes outbound communications related to the credentialing events.
- Research discrepancies related to provider information.
- Supports the preparation of weekly rosters to present providers for committee approvals/denials.
- Supports credentialing audits by pulling files and preparing the files for presentation to external clients.
- Obtains missing information from various sources including the provider to ensure provider maintains compliance with Eye Med Network.
- Executes reports to review and make necessary updates to provider information and provide status to management.
- Prepare reports of status on credentialing activities.
Basic Qualifications:
- High School Diploma.
- 2-3 years business experience with healthcare provider credentialing.
- Proficient in Microsoft Office Products (Word, Excel, Access).
- Excellent communication skills (written/verbal).
- Ability to work well independently, under pressure and multi-tasking.
- Ability to successfully work on multiple projects simultaneously while managing time effectively.
Preferred Qualifications:
- Associate or Bachelor s Degree.
- Knowledge of credentialing/provider industry.
- Demonstrates sense of urgency.
- Experience with operating systems such as EDW/Business Objects.