Credentialing Specialist - TSS

Triple S Management Corporation and Subsidiaries • PR

79d

About The Position

At Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results. When you join Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join now! Independently performs tasks that require knowledge and implementation of policies, procedures and general methods of operation. Responsible for collecting information based on facts, conducting research and analysis and make recommendations that will be used by others to a higher hierarchical level. Evaluates complex situations that require application and knowledge of policies, methods and procedures for recruitment. The use of the trial is focused on collecting, organizing and presenting information relevant to a situation or problem, channeling the supervisor those unusual situations or not covered by procedures. Collaborate and participate in functions related to the procurement process, credentialization and in the development of strategies to maintain the adequacy of the network.

Requirements

• Associate degree (AD) or at least 60-64 college credits.
• One (1) to three (3) years of related experience.

Responsibilities

• Reviews Provider’s application and ensures that it has been appropriately completed with all required documentation according to the provider specialty, provider type and or contracted services as required by the federal regulatory (CMS), local government requirements (ASES), URAC Accreditation and company’s policies and procedures as part of the credentialing and recredentialing processes.
• Coordinates obtaining information from internal and external (Primary and Secondary Sources) sources to ensure receipt of the necessary documents to complete the Credentialing process and/or Recredentialing process documentation.
• Updates Credentialing and Recredentialing information and documentation in the credentialing software’s and/or tracking tools.
• Contacts the Provider’s as needed (via email and/or phone) to ensure receipt of the documents to complete the credentialing process or re credentialing.
• Prepares reports related to the credentialing and recredentialing process activities for supports tracking and maintenance of metrics for the department.
• Prepares and audits the file containing the documentation in accordance with criteria established by the regulatory agencies and company’s policies and procedures for review and determination by the Credentialing Committee.
• Manages confidential Provider’s information according to policies, procedures, and applicable regulations.
• Acts as the primary point of contact and liaison for all internal and external customers on issues, concerns, questions, or situations of the credentialing process.
• Participates in projects and assists in the implementation of systems and procedures to ensure that all credentials and accreditation processes are performed according to the regulations, policies, and standards.
• Performs other tasks related as assigned by the supervisor and that are essential to the corporation's objectives and division operational plans.

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees