Provider Services - Credentialing Specialist 115-1021

Community Care • Tulsa, OK

1d

About The Position

JOB SUMMARY:Responsibilities include performing credentialing activities consistently for each applicant in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans of Oklahoma Policy and Procedure Manual. KEY RESPONSIBILITIES: Responsible for initial assessment of applications and other data for accuracy and completeness and contacting applicants or other outside resources to resolve questions or to obtain missing information. Coordinates the completion of an applicant’s file and review for completeness and accuracy. Responsible for entering accurate credentialing elements relevant to each applicant in the database. Responsible for monitoring and assessing reports to ensure providers are credentialed in accordance with state mandates, and policy and procedures. Responsible for provider file maintenance. Perform other duties as assigned.

Requirements

• Possess strong oral and written communication skills.
• Ability to interpret and communicate information efficiently and effectively.
• Successful completion of Health Care Sanctions background check.
• Ability to handle multiple tasks and projects simultaneously and strong organizational ability.
• Ability to maintain a positive working environment, project a positive attitude, and be a self-starting individual and maintain a team player attitude.
• Ability to handle confidential information in a professional and sensitive manner.
• Ability to converse and write fluently in English.
• High school diploma or equivalent.
• Associates degree OR high school diploma plus two (2) years related healthcare/managed healthcare experience.

Nice To Haves

• Basic Medical Terminology preferred
• Credentialing experience in a managed care organization or hospital setting preferred.

Responsibilities

• Responsible for initial assessment of applications and other data for accuracy and completeness and contacting applicants or other outside resources to resolve questions or to obtain missing information.
• Coordinates the completion of an applicant’s file and review for completeness and accuracy.
• Responsible for entering accurate credentialing elements relevant to each applicant in the database.
• Responsible for monitoring and assessing reports to ensure providers are credentialed in accordance with state mandates, and policy and procedures.
• Responsible for provider file maintenance.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 251-500 employees