Managed Care Credentialing Representative II

Brightli • Springfield, MO

2d • Onsite

About The Position

Join a compassionate, collaborative team committed to supporting provider access to help shape timely credentialing that directly impacts patient services, work in a role with clear growth opportunities, use your attention to detail to ensure compliance, enjoy variety through provider interaction and file management, and contribute to an organization that values integrity and teamwork. You will guide providers through onboarding and recredentialing processes, manage credentialing files in the database, verify practitioner background and credentials, and coordinate application progress through committee review under limited supervision of the Managed Care Credentialing Lead.

Requirements

• High school diploma, GED, or equivalent required.
• Healthcare credentialing experience.
• Excellent customer service, time management, and verbal/written communication skills.
• Strong organizational skills and attention to detail.
• Analytical and research abilities to translate industry topics and policies into actionable items.
• Ability to multitask across projects and meet multiple deadlines.
• Successful completion of background checks (criminal record, driving record, abuse/neglect, fingerprint).
• Current driver’s license, acceptable driving record, and current auto insurance.
• Completion of New Hire Orientation and required training (including Relias) at hire and annually thereafter.

Nice To Haves

• Experience in healthcare administration and proficiency with Microsoft Office (including Excel) preferred.

Responsibilities

• Meet with onboarding providers to navigate applications and enrollment, answering questions and resolving concerns.
• Complete provider credentialing and recredentialing applications and follow up to drive timely submission and approvals.
• Compile, maintain , and update accurate provider data in the credentialing database and file system.
• Investigate and document practitioner credentials—verify background, training, licensure, and past practice using specialized methods.
• Coordinate application files for committee review and ensure regulatory items are present and current.
• Notify supervisors/management of adverse or questionable verification responses.
• Assist providers with changes in privileges or license types as needed.
• Maintain department standards and ensure compliance with applicable regulations.
• Perform other duties as assigned.

Benefits

• Employee Assistance Program – 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost
• Mileage Reimbursement – Company paid for work functions requiring travel
• Employee Discounts – Hotels, Theme Parks & Attractions, College Tuition
• Paid time off: full-time employees receive an attractive time off package to balance your work and personal life
• Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more
• Top-notch training: initial, ongoing, comprehensive, and supportive
• Career mobility: advancement opportunities/promoting from within

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED