Credentialing Specialist

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TITLE: Credentialing Specialist
JOB DUTIES:
Will be responsible for acquiring and retaining all knowledge and skills necessary for interpreting and responding to credentialing and re-credentialing policies and procedures.
ESSENTIAL FUNCTIONS:
1. Enter updated information into the PIP system via the PC; research provider application information as it relates to assigned function.
2. Ensure renewal updates are received within specified time frames of the credentialing process and satisfy the TDI Regulations for the HMO product.
3. Monitor reports to support the credentialing process for providers in opened process.
4. Perform in-depth research for providers identified as having system discrepancies according to the NTIS (National Technical Information Service) report.
5. Communicate with external agencies (boards, hospitals, provider offices, etc.) via telephone, to provide follow-up on requested verifications.
PAY: $15.00 an hour
HOURS: 8 AM – 5 PM, Monday - Friday
JOB REQUIREMENTS
*9 months credentialing or healthcare field
*PC experience to include Windows, Word, Excel, and business databases
*Strong verbal and written communication skills
*Organizational skills and decision-making ability
*Ability to multi-task
PREFERRED JOB REQUIREMENTS
*Access experience
*Knowledge and understanding of NCQA/MCO/CVO guidelines and requirements
*Knowledge of RNPS and PIP or similar provider databases
*Bi-lingual English/Spanish
BENEFITS:
Competitive starting wages
Monday through Friday work schedule
Paid holidays
Year-end bonus program
Portable 401(k) plans
Recognition and incentive programs
Access to continuing education via the Kelly Learning Center