Facility Credentialing Specialist

American Health Partners•Franklin, TN

43d•Remote

About The Position

The Facility Credentialing Specialist ensures all contracted providers meet qualifications to provide care by working closely with multiple departments. This position is also responsible for assisting and supporting reporting functions of data to appropriate agencies, committees and management while meeting Health Plan standards.

Requirements

Must be fluent in all provider types
Must be able to accept instructions and work independently in the completions of goals and assignments
Proficient computer skills
Must be self-motivated, dependable, team and goal-oriented
Ability to accurately enter data into information system as instructed
Ability to prioritize and multi-task workload
Be efficient, effective and assertive in both written and spoken communications
Handle multiple priorities effectively
High school diploma or equivalent required
Previous experience in the healthcare field required
Prior credentialing experience required
Must be able to speak and write in English

Nice To Haves

Post-secondary education preferred
Prior experience in network services data management preferred
Prior experience with Medicare Advantage plans preferred

Responsibilities

Although this position can assist with provider credentialing, the main focus for this position will be Facility Credentialing.
Must be able to review and verify credentials, i.e. licenses, certifications, etc., in a timely manner
Make sure organizations are compliant with regulatory requirements.
Maintain and load provider credentialing information received via contracts, roster updates and/or applications into the system
Review data for accuracy, correct errors as needed
Keep current on NCQA Standards and/or industry-specific regulations
Contact providers in a timely manner to obtain missing and/or incorrect documentation: follow up as necessary
Participate on calls with network services staff to assist with troubleshooting
Assist with the facilitation of the Credentialing Committee approval and denial notification process (i.e. welcome and denial letters)
Other duties as assigned