Credentialing Specialist
About The Position
NeueHealth is a value-driven healthcare company focused on making healthcare accessible and affordable. We achieve this by aligning the interests of consumers, providers, and payors across various health insurance marketplaces. The Credentialing Representative plays a crucial role in the day-to-day execution of the provider credentialing process. This involves ensuring providers meet all necessary requirements and compliance standards, obtaining required documentation, maintaining credentialing records, and adhering to state, federal, and regulatory guidelines. The role supports the overall credentialing program through collaboration with internal teams and external vendors.
Requirements
- High School diploma or GED required
- One (1) or more years of experience in credentialing, managed care, or a related healthcare field.
- Proficiency with Microsoft Office, particularly Excel.
Nice To Haves
- Associate's degree or Bachelor’s degree in healthcare administration or related field preferred.
- Experience with credentialing software is a plus.
Responsibilities
- Assist in executing key components of the credentialing process, including reviewing and processing credentialing applications, maintaining credentialing files, and tracking application status.
- Work with providers to obtain missing documentation or information required for the credentialing process.
- Ensure that all credentialing activities adhere to company policies, state and federal regulations, and URAC requirements.
- Maintain up-to-date records and credentialing documentation for all providers, ensuring accuracy and completeness.
- Assist in preparing and submitting credentialing files for review, including both clean and risk files.
- Communicate with providers regarding the status of their credentialing applications, gathering additional information as needed and providing guidance on the credentialing process.
- Send out determination letters based on the Credentialing Committee’s decisions.
- Provide administrative support by managing credentialing file feeds, updating credentialing systems, and maintaining provider tools as required.
- Assist in maintaining provider manuals and other credentialing resources.
- Collaborate with internal teams and participate in cross-functional initiatives to ensure smooth credentialing operations.
- Perform other related tasks and responsibilities as assigned to support the overall credentialing program.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
