Credentialing & Provider Data Management
Credentialing Specialist
Credentialing & Provider Data Management, Honolulu, Hawaii, United States, 96814
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Department:
Credentialing & Provider Data Management
AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.
AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.
The Opportunity: The Credentialing Specialist initiate, maintain and monitor AlohaCare’s credentialing processes to ensure conformance with established department and organizational policy and procedures, national accreditation standards, and contractual state and federal requirements within expected timeframes.
Primary Duties and Responsibilities:
Performs all AlohaCare credentialing processes and activities to ensure QUEST integration and Advantage Plus (CMS SNP) network adequacy requirements are met which include Individual Providers/Practitioners; Facilities; Long Term Services and Support (LTSS) providers credentialing for contracting purposes.
Perform verification of credentialing information and complete primary source verification activities as needed.
Performs internal audits of credentialing file reviews for quality assurance purposes
Prepares, organizes and maintains assigned credentialing files along with relevant documents to support credentialing processes within expected timeframes.
Assists with coordination and preparation of assigned credentialing files for committee meeting presentation, review and determination.
Contributes to the development and revisions of applicable workflows and processes to support department and organizational business needs.
Performs data entry, maintains and monitors credentialing databases to support day-to-day operations of credentialing activities.
Communicates, both verbally and in writing with providers, administrators and their staff members regarding credentialing activities and processes.
Assists the Provider Relations, Credentialing and Data Management teams with credentialing inquiries providing responses and resolution in a timely manner.
Collaborates and communicates with the Provider Relations and Contracts Team relative to Credentialing projects and activities.
All other duties assigned.
Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
Responsible to maintain confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees are granted access to AlohaCare’s owned and subcontracts data bases with specific data classifications assigned to this job title.
Minimum of 1 year of Provider and Facility Health Plan credentialing experience
Minimum of 1 year of administrative and/or clerical experience
Minimum of 1 year of customer service experience
Able to work independently with minimal supervision.
Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
Data entry experience with a high degree of accuracy and attention to detail.
Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint
National certification as credentialing specialist.
May require prolonged sitting- up to 4 hours.
Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday. ?
Salary Range: $16.50 - $21.30 an hour
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders. #J-18808-Ljbffr
Join our team!
Current job opportunities are posted here as they become available.
Subscribe to our RSS feeds to receive instant updates as new positions become available.
Department:
Credentialing & Provider Data Management
AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.
AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.
The Opportunity: The Credentialing Specialist initiate, maintain and monitor AlohaCare’s credentialing processes to ensure conformance with established department and organizational policy and procedures, national accreditation standards, and contractual state and federal requirements within expected timeframes.
Primary Duties and Responsibilities:
Performs all AlohaCare credentialing processes and activities to ensure QUEST integration and Advantage Plus (CMS SNP) network adequacy requirements are met which include Individual Providers/Practitioners; Facilities; Long Term Services and Support (LTSS) providers credentialing for contracting purposes.
Perform verification of credentialing information and complete primary source verification activities as needed.
Performs internal audits of credentialing file reviews for quality assurance purposes
Prepares, organizes and maintains assigned credentialing files along with relevant documents to support credentialing processes within expected timeframes.
Assists with coordination and preparation of assigned credentialing files for committee meeting presentation, review and determination.
Contributes to the development and revisions of applicable workflows and processes to support department and organizational business needs.
Performs data entry, maintains and monitors credentialing databases to support day-to-day operations of credentialing activities.
Communicates, both verbally and in writing with providers, administrators and their staff members regarding credentialing activities and processes.
Assists the Provider Relations, Credentialing and Data Management teams with credentialing inquiries providing responses and resolution in a timely manner.
Collaborates and communicates with the Provider Relations and Contracts Team relative to Credentialing projects and activities.
All other duties assigned.
Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
Responsible to maintain confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees are granted access to AlohaCare’s owned and subcontracts data bases with specific data classifications assigned to this job title.
Minimum of 1 year of Provider and Facility Health Plan credentialing experience
Minimum of 1 year of administrative and/or clerical experience
Minimum of 1 year of customer service experience
Able to work independently with minimal supervision.
Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
Data entry experience with a high degree of accuracy and attention to detail.
Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint
National certification as credentialing specialist.
May require prolonged sitting- up to 4 hours.
Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday. ?
Salary Range: $16.50 - $21.30 an hour
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders. #J-18808-Ljbffr