Managed Care Credentialing Specialist - Full Time

Pennant Services

11d•Onsite

About The Position

Acts as the liaison between our Agencies/Facilities and our managed care plan partners. Participates in strategic decisions and efforts as they pertain to new contracting opportunities, maintains tools and processes to support the completion of timely, compliant, and accurate managed care credentialing applications. A qualified candidate will have a minimum of three years of experience in credentialing. The Managed Care Credentialing Resource will play a vital role in ensuring that our organization maintains compliance with all credentialing requirements set forth by managed care organizations. This individual will be responsible for managing the credentialing process for Pennant Home Health, Hospice, Personal Care Agencies, and Senior Living Facilities within our organization, ensuring that they meet the necessary qualifications and standards to participate in various managed care networks. The ideal candidate will have a strong understanding of credentialing procedures, excellent organizational skills, and the ability to collaborate effectively with internal and external stakeholders.

Requirements

3 + years of credentialing experience or healthcare administrative experience.
Strong organizational skills and attention to detail.
Demonstrated professionalism and exceptional interpersonal skills.
Ability to adhere to strict confidentiality guidelines and operate with the utmost integrity, discretion, and strong sense of ethics.
Strong written and verbal communication skills required.
Teamwork-oriented, self-motivated with a willingness to learn and adopt new strategies.
Able to follow through with delegated tasks, assume accountability, and take initiative in all aspects of the role.
Resourcefulness in problem-solving.
Intermediate to advanced computer skills, including proficiency in MS Office applications (Excel, Word, Outlook, PowerPoint, SharePoint, Smartsheet), along with Adobe PDF.
Dedicated to accuracy and results.
Knowledge of commonly used credentialing concepts, practices, and procedures.
Excellent time management and multi-tasking abilities.
Demonstrated ability to function independently with minimal direct supervision.
Ability to embrace Pennant’s core values and culture.

Nice To Haves

Home Health, Hospice, Personal Care and Senior Living Community credentialing experience.
Knowledge of Managed Care Health Plan in Tennessee, Georgia, and Alabama.

Responsibilities

Responsible for all aspects of credentialing and re-credentialing for assigned geographic regions.
Ensure full compliance with all applicable policies, procedures, bylaws, rules, and regulations, accreditation standards, and regulations for the processing of applications for initial credentialing and re-credentialing.
Communicate with managed care organizations to obtain and verify credentialing requirements, submission guidelines, and status updates.
Ensure that all credentialing applications are completed accurately and submitted in a timely manner to meet managed care organization deadlines.
Coordinates with Legal, Licensing, Accounts Receivable, and Payor Admin to verify and obtain pertinent information.
Maintain a comprehensive database of Agency/Community credentialing documents.
Represent Agencies/Communities and company professionally to all managed care plans and external partners.
Assist Managed Care Resources and team with special contracting projects as assigned.
Manage the assigned credentialing email inbox.
Serve as a liaison between Agencies/Communities and managed care organizations regarding credentialing matters, responding to inquiries, and providing necessary information as needed.