Job Description

Position Purpose:  Reporting to the Director of Credentialing & Provider Enrollment, the Credentialing Assistant facilitates the intake of daily ongoing Credentialing requests overseen by the Quality Management Department.

 

Oversee and triage incoming department Emails. Monitor and assign Credentialing files to Credentialing Coordinators. Notify internal departments and providers of Credentialing status. Responsible for accurate and timely generation of Credentialing Provider Data Maintenance (PDM) shells into database for initiation of Credentialing process.

 

Facilitates timely coordination with the Credentialing Verification Organization (CVO) to ensure prompt processing of Primary Source Verification, further ensuring overall processing timeframes are met. Manage daily receipt of Credentialing Data Transmission (CDT) files from CVO for prompt processing by Credentialing Coordinators. Escalate any issues identified in relation to work in progress (WIP) or Credentialing files received by CVO to department management.

 

Responsible for ensuring providers CAQH applications are current and all required documents are present in order to begin Credentialing process with CVO. Coordinates with Network Services, providers or other sources as necessary on follow-up items needed to complete the credentialing process.

 

Responsible for maintenance of updating Credentialing database and/or departmental tracking logs to reflect Credentialing Committee statuses, decisions, and generation of Credentialing Committee decision letters.

 

Maintain on-going participation in cross-training activities, ensuring appropriate staff coverage of incoming volume. Actively engage in addressing special projects as they arise, conducting preliminary research and follow-up, and tracking/monitoring to facilitate on-going reporting of project status. Provide recommendations and feedback regarding development of process improvements and/or standardization practices. Other duties as assigned.



Qualifications

Education:   

·         Associates degree in a related field (or equivalent combination of education and experience).

Years of Experience:  

·         1-3 years administrative experience, preferably within a credentialing/recredentialing environment and knowledge national accreditation or regulatory criteria.

Work Related Experience:  

·         Familiarity with Microsoft Office software (Outlook, Word, Access, Excel, PowerPoint)

·         Previous Managed Care and/or Medicaid experience strongly 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.

Specialized Knowledge:  

·         Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan provider enrollment and credentialing preferred.

·         Excellent organizational skills, proven project management expertise; Strong verbal and written communication skills.

·         Outstanding interpersonal skills, able to quickly establish a trusting rapport with individuals at all levels.

·         Requisite poise, judgment, and trustworthiness to represent SHCN to internal and external groups.

·         Maintains information in a confidential manner according to policy.

Application Instructions

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