Credentialing Assistant
Job Description
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Our Vision:
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
Position Purpose: Reporting to the Director of Credentialing, the Credentialing Assistant facilitates the intake, data entry, and finalization of Credentialing requests.
Responsibilities:
- Intake, data enter, and scrub initial credentialing requests
- Import CAQH, CVO, and delegated entity txt files into the eVIP’s application
- Oversee and triage incoming department emails
- Monitor workflows in the eVIPs application assign files to Credentialing Coordinators as applicable
- Provide status updates and notification of credentialing completion to internal departments
- Clearly communicate credentialing rejections to Network Services staff
- Submit credentialing files to the Credentials Verification Organization (CVO). Monitor credentialing files through processing with the CVO and ensure timely delivery to Credentialing Coordinators
- Manage and import of daily receipt of Credentialing Data Transmission (CDT) files from CVO into eVIPs application
- Escalate any issues identified in relation to work in progress (WIP) or credentialing files received by CVO to department leadership
- Ensure providers CAQH applications are current and all required documents are present in order to begin credentialing process with CVO
- Coordinate with Network Services, providers, or other sources as necessary on follow-up items needed to complete the credentialing process
- Maintain credentialing status within the eVIPs application. Update credentialing approval dates. Generate welcome letters and recredentialing approval letters and distribute to providers
- Maintain ongoing participating in cross-training activities
- Actively engage in addressing special projects as they arise
- Provide recommendations and feedback regarding development of process improvements and/or standardization practices
- Other duties as assigned
Education / Experience / Other Requirements
Education:
- Associates degree in a related field (or equivalent combination of education and experience)
Years of Experience:
- A minimum of one year administrative experience, preferably within a credentialing/recredentialing environment and knowledge national accreditation or regulatory criteria.
Specialized Knowledge:
- Familiarity with Microsoft Office software (Outlook, Word, Access, Excel, PowerPoint)
- Familiarity with credentialing database software preferred (symplr, CACTUS, MD-Staff)
- Thorough understanding of managed care credentialing preferred
- Ability to analyze and evaluate data and other provider related problems in order to develop alternative solutions for a positive outcome
- Ability to multi-task and prioritize workload, manage multiple priorities, and pay meticulous attention to detail
- Excellent organizational skills
- Strong verbal and written communication skills
- Outstanding interpersonal skills, able to quickly establish a trusting rapport with individuals at all levels
- Maintains information in a confidential manner according to policy
*This position is located in Phoenix, Arizona*
Application Instructions
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