Location: Minneapolis,MN, USA
Description
Hennepin Health is seeking a Senior Credentialing Specialist. This position will investigate and verify credentialing and re-credentialing applications in accordance with the National Committee for Quality Assurance (NCQA), Center for Medicare and Medicaid (CMS), Minnesota Department of Human Services (DHS), and Minnesota Department of Health (MDH) standards for all contracted providers.
Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500 referral bonus. For more information visit employee referral program page.
Location and hours:
This position is a hybrid position with 85% of time remote and 15% onsite on the eighth floor at the Human Services building at 525 Portland Avenue South, Minneapolis, MN 55415. Onsite work will be required for onboarding and training. Work hours are primarily Monday through Friday, 8 a.m. to 4:30 p.m. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin.
About the position type:
This is a full time, benefit-earning position.
This position is internally classified as a Community Health Worker, Senior.
Click here to view the job classification specification.
In this position, you will:
* Conduct thorough investigations of practitioner and facility credentialing applications to determine eligibility status as defined in Hennepin Health's credentialing program.
* Perform credentialing investigation and primary source verification for provider initial and re-credentialing of assigned providers utilizing CMS, DHS, and NCQA standards and other federal and state regulatory requirements; ensure timely verification to prevent any negative impact related to compliance or regulatory requirements.
* Maintain timely communication with external providers regarding the eligibility and credentialing decisions and/or related provider issues.
* Serve as a resource specialist for internal departments for daily issues related to provider credentialing activities.
* Identify administrative and professional issues that require additional investigation and evaluation; validate discrepancies and ensure appropriate follow up with provider, manager and cross-departments.
* Enter and maintain credentialing data in credentialing system of record following NCQA standards, as well as state and federal requirements.
* Assist in development and implementation of credentialing policies and procedures.
* Identify practitioners who are not in compliance with credentialing criteria and assist leadership in preparing the appropriate documents for review by the Credentialing Committee.
* Operate in the mode of continuous improvement with an eye for operational proficiencies.
Need to have:
* One of the following:
* Completion of two or more years of college, in social/ behavioral sciences or a field related to the area.
* Note: Related experience working for a health maintenance organization, health plan, and/or in another health insurance-related setting may be substituted for education on a year for year basis.
Nice to have:
* Two years or more of credentialing experience, within the last five years.
* Experience with:
* Managed Care Organizations (MCO's) and Centers for Medicare & Medicaid Services (CMS) credentialing and registration requirements.
* NCQA Credentialing Standards and Guidelines.
* Processing primary source verifications.
* Microsoft Office (Word, PowerPoint, and Excel) and the use of the internet.
* Providing culturally competent services.
* Regulatory environments.
* Training or technical assistance.
* Using effective presentation and facilitation skills.
* Knowledge of:
* Credentialing Committee and case file preparation.
* Provider and practitioner credentialing process, timeframes and appeal options; health plan design, contracting, plan policies and procedures; MCO reporting and recordkeeping requirements.
* Ability to:
* Interpret policies and procedures and use plain language in the enforcement of federal and state regulations.
* Build professional cross functional working relationships among all levels of the organization.
* Make valid judgments, formulate recommendations or action plans, and evaluate the effects of decisions and actions.
* Maintain detailed documents in an organized, accurate, and systematic manner; follow and provide instructions.
* Communicate effectively, both verbally and in writing, to a variety of internal and external partners.
About the department:
Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well-being of our members and the community.
About Hennepin County:
Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align with our mission to serve residents through transformative services that reduce disparities, eliminate inequities, and create opportunity for all and our vision of a community where all people are healthy, all people are valued, and all people thrive.
Our employees receive a combination of competitive benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge (login as Guest).
Hennepin County envisions an organization where our commitment to diversity is fundamental in providing excellent service to our community.
Your future. Made here.
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This posting may be used to fill current and future vacancies.
This position will have access to systems or other documentation that contains HIPAA data.
Invitations to interview will be based upon an assessment of education and experience.
Final candidates may be required to complete a drug test and/or background check.
If you have any questions, please contact:
Talent Acquisition Division
Hennepin County Human Resources Department
...@hennepin.us
612-###-####
Why work here?
Hennepin County embraces the Total Rewards philosophy. We want our employees to succeed - not only at work but as they move through life and its milestones. We offer advantages and opportunities others can't - including:
* Meaningful work
* Public service
* Competitive pay
* Work-life balance
* Generous benefits
* Opportunities to grow
* Commitment to your success
By working in public service, we are a part of something larger than ourselves. Together, we support those in need. We help people access information and services. We empower vibrant and diverse communities. We serve residents.
Employee Benefits Summary
Visit our benefits page to learn more: bridge.hennepin.us/eligibility.
If you are a current Hennepin County employee please be aware that any change in job classification may affect your current benefits (such as a conversion from Vacation/Sick Leave to Paid Time Off and/or enrollment in a Health Care Saving Plan.) Information about the impact of job changes on benefits can be found here.
01
This position is a hybrid position with 85% of time remote and 15% onsite on the eighth floor at the Human Services building at 525 Portland Avenue South, Minneapolis, MN 55415. Onsite work will be required for onboarding and training. Work hours are primarily Monday through Friday, 8 a.m. to 4:30 p.m. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin. Are you willing and able to meet this requirement?
* Yes
* No
02
Which of the following best describes your education and/or experience?
* I have completed two or more years of college, in social/behavioral sciences, or a related area.
* Two of more years of experience working for a health maintenance organization, health plan, and/or in another health insurance-related setting.
* I have a combination of experience and education totaling two or more years.
* None of the above
03
How many years of college have you completed in social/behavioral sciences or a field related to the area?
* Less than 1 year
* 1 year or more, but less than 2 years
* 2 years or more
* None
04
Describe your education in social/behavioral sciences or a field related to the area, making reference to school(s) listed in your application/resume including degree(s)/certificate(s) received. If you do not have this education, type 'None' in the space provided.
05
How many years of experience do you have working for a health maintenance organization, health plan, and/or in another health insurance-related setting?
* I do not have this experience
* Less than 1 year
* 1 year or more, but less than 2 years
* 2 years or more
06
Describe your experience working for a health maintenance organization, health plan, and/or in another health insurance-related setting, referencing jobs from your application/resume. If you do not have this experience, type None in the space provided.
07
Do you have two years or more of credentialing experience, within the last five years?
* Yes
* No
08
Describe your credentialing experience within the last five years, referencing jobs from your application/resume. If you do not have this experience, type None in the space provided.
09
How many years of experience do you have with Managed Care Organizations (MCO's) and Centers for Medicare & Medicaid Services (CMS) credentialing and registration requirements?
* I do not have this experience
* Less than 1 year
* 1 year or more, but less than 2 years
* 2 years or more, but less than 3 years
* 3 years or more, but less than 4 years
* 4 years or more, but less than 5 years
* 5 years or more
10
Describe your experience with Managed Care Organizations (MCO's) and Centers for Medicare & Medicaid Services (CMS) credentialing and registration requirements, referencing jobs listed on your application/resume. If you do not have this experience, type None in the space provided.
11
Please choose the one recruitment source that best describes how you first learned about this job opening. Please review all possible choices before making your selection. Your response to this question helps us evaluate the effectiveness of our recruitment methods.
* College or university (job board, career services, or instructor)
* Community or nonprofit organization (counselor, job board, etc.)
* Employee or recruiter of Hennepin County
* Friend or family member that is not a Hennepin County employee
* Hennepin County job notification emails
* Indeed.com
* Job fair or networking event
* Print advertisement (flyer, postcard, billboard, transit ad, etc.)
* Professional association (job board or email)
* Social media (Facebook, Twitter, Instagram, etc.)
* www.hennepin.jobs or www.governmentjobs.com
* Other
12
For the recruitment source selected above, please provide the specific name of the person, website, or media source.
Required Question
Agency Hennepin County
Address Hennepin County Government Center
300 South Sixth Street
Minneapolis, Minnesota, 55487
Phone 612-###-####
Website