Credentialing Specialist - Health Plan

Location: Norfolk, VA
Date Posted: 03-13-2018
Quality Management Credentialing Associate- Managed Care
** This is a Full-Time, Benefits Available, CONTRACT opportunity, expected to last 3 months, or longer! **
Your Job Summary: 
The Credentialing Associate is responsible for providing credentialing and credentialing support to the medical providers at the health plan and contracted provider network through the processing of applications and reapplications to ensure that only qualified practitioners provide care within the network facilities.  Provides credentialing support to the centralized appointment and reappointment process including reports and obtaining required data from Quality Assurance profiles and National Practitioner Data Bank reports, in accordance with the National Commission on Quality Assurance (NCQA) and The Joint Commission.
Your Background:
Requires an education level of at least a high school diploma or GED.
At least 1-2 years healthcare credentialing experience is required.
Strongly prefer prior healthcare database experience and experience working in hospital administration.
Basic familiarity with healthcare / medical industry is required.
Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
Ability to analyze and integrate information and make sound decisions based upon established guidelines.
Resourcefulness as demonstrated by the effective application of professional knowledge to new situations.
Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.

Your Duties:
  • Provide credentialing support to the credentialing manager. 
  • Maintain a sound working knowledge of credentialing trends and changes.
  • Provide consultation to the medical staff regarding credentialing matters.
  • Ensure all processes are in compliance with state statutes and regulatory agencies as demonstrated by observation.
  • Complete physician applications for the state medical licenses and hospital privileges.
  • Work closely with the state licensing boards and hospital medical staff offices.
  • Help keep physician credentials up to date, administer tracking, and reminder system.
  • Filing, data entry, and database maintenance.
  • Responsible for maintaining and securing confidential and time sensitive material.
  • Ability to follow through on all projects
  • Strong communication skills across various internal departments

CareNational Healthcare Services
623.201.8732 (CALL – TEXT – FAX)
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