Associate Credentialing Representative

Job Description

REQUIREMENTS

• High School Diploma or GED
• 0-1 years of experience
• Experience in Provider Data Management, Customer Services or Claims.
• Microsoft office experience (i.e. Word, Excel, PowerPoint, etc.)

Preferred

• A familiarity with credentialing processes and the URAC standards.
• Experience in the use of ULTRA and Dental Provider File systems.
• Experience with the Customer Service inquiry system or claims processing concepts.

RESPONSIBILITIES

• Credential and re-credential providers.
• Contact providers or representatives by telephone or in writing to obtain additional information while processing their enrollment applications.
• Screen incoming applications and paperwork for completeness and accuracy and sends necessary paperwork to credentialing vendor.
• When necessary performs credentialing verifications and loads provider to appropriate networks and credentialing information to the provider database.
• Manage credentialing inventory, reports and projects to ensure all established time frames for completing work, reports and projects are met.
• Depending on level, train credentialing team in the use of various systems, software, databases, processes and procedures.
• Create and distribute monthly reports as assigned and handle complex and unusual or high-level credentialing issues.
• Support projects, audits, business partners, internal departments and external clients.
• Represent department as the Subject Matter expert.
• Pull and research necessary documentation for audits
• Support updates necessitated by our business partners, internal departments and external clients.
• Provide customer oversight for our customers who have unique requirements and timelines to ensure compliance.
• Depending on level, investigate interim license actions.
• Participate in projects which streamline, automate, or otherwise enhance credentialing functions.
• Other duties as assigned or requested.

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