Credentialing Specialist

Unite Here Health•Las Vegas, NV

37d•$26 - $31•Hybrid

About The Position

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity! This is a Culinary Health Fund position The Credentialing Specialist is responsible for all aspects of provider credentialing including but not limited to processing initial and re-credentialing applications for network of approximately 6000 providers 1500 + contracts. They will develop and maintain excellent on-going relationships with the providers and vendors, keeping satisfaction and engagement high. The specialist will be able to independently perform the functions of the Physician and Ancillary facility credentialing policies and procedures.

Requirements

3 ~ 5 years of direct experience
Efficient with contracting and credentialing software
Complete understanding of physician contracts and reimbursement protocol
Current knowledge of NCQA credentialing standards
Exceptional written and verbal communication skills
Existing knowledge of medical terminology
Bachelor's degree or related field or equivalent work experience required

Nice To Haves

Working knowledge and experience in provider relations, managed care, provider practice or similar setting, preferred

Responsibilities

Develop and maintain excellent on-going relationships with providers and vendors
Responsible for all aspects of provider credentialing including but not limited to processing initial and re-credentialing applications for network of approximately 5000 providers
Communicate with Fund's Credentialing Verification Organization to coordinate timely processing of files including being a liaison between the CVO and network providers to obtain information needed to complete the credentialing process
Create and maintain all provider credentialing information in Fund's provider database
Maintain all ancillary provider monitoring documents including GLPL, state licensing, accreditations, Medicare certification, and business licensing.
Responsible for preparing and distributing meeting materials for Fund's Credentialing Committee Meetings
Attend Credentialing Committee Meetings, interact with committee physicians, record and type meeting minutes for Legal and Committee Chairman review and approval
Prepare post-meeting correspondence to providers as needed and ensure that all requests for information from Credentialing Committee are completed and prepared to report on at next meeting or as requested.
Responsible for updating Fund's credentialing policies and procedures when necessary and confirm all NCQA standards are upheld or revised as needed.
Performs the above listed position functions independently (or with limited supervision) and within time frame defined for the specific task by Fund management
Organize, prioritize and work on a variety of assignments
Exemplifies the Fund's values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement