Credentialing Specialist

Moda Health•Portland, OR

2d•Remote

About The Position

Performs verification activities associated with credentialing and re-credentialing Moda-contracted providers, following Moda policies, National Committee for Quality Assurance (NCQA) standards, and state and federal requirements. This is a full-time work-from-home position. Pay is $19.43–$21.86 per hour, depending on qualifications; applicants who meet only the minimum qualifications are eligible for the low end of the range. The role verifies provider credentials through approved sources, monitors credentialing and re-credentialing applications, maintains credentialing records and database information, and communicates with providers and relevant offices about application status and documentation. It also manages provider data received from delegated entities and reports compliance or credentialing issues to the credentialing supervisor. The work is performed in an office environment with extensive close computer and keyboard use, constant sitting, and frequent phone communication. The position requires navigating multiple computer screens and a reliable, high-speed, hard-wired internet connection to support remote or hybrid work. The employee must be comfortable appearing on camera for virtual training and meetings. Work beyond the standard workweek, including evenings and occasional weekends, may be needed to meet business needs. The role has regular internal contact with other departments and external contact with vendors, providers, health professionals, physician offices, IPAs, delegates, rented networks, hospitals, and licensing boards.

Requirements

Type at least 50 words per minute and have ten-key proficiency of 135 kspm net.
Strong organizational and time-management skills.
Ability to meet deadlines, maintain confidentiality, produce high volumes of work, and work independently as well as in a diverse team environment.
Ability to problem-solve, retain information, and demonstrate strong attention to detail.
Excellent verbal, written, and interpersonal skills.
Maintain a professional appearance and demeanor in internal and external interactions.
Reliable, high-speed, hard-wired internet connection to support remote or hybrid work.
Comfort with being on camera for virtual training and meetings.
Ability to work beyond the standard workweek, including evenings and occasional weekends, as business needs require.

Nice To Haves

Working knowledge of NCQA, the Centers for Medicare and Medicaid Services, and Oregon Health Authority or other state credentialing standards.

Responsibilities

Verify provider credentials accurately and on time using approved sources.
Monitor requests for and receipt of credentialing and re-credentialing applications.
Complete documentation and enter information into the credentialing database.
Identify and report non-compliance or credentialing issues to the credentialing supervisor.
Communicate with providers or office staff about Moda’s credentialing process, application status, and required documentation.
Update provider demographics in the database.
Manage provider data within the credentialing database from delegated entities.
Maintain the confidentiality and security of documents, records, and data.
Perform other duties as assigned.