Credentialing Specialist

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday-Friday

Job Location : Remote

The role you'll contribute:

The Credentialing Specialist reports to the Network Operations Manager. The Credentialing Specialist is responsible for activities associated with credentialing or re-credentialing of network providers, including review of providers credentialing documentation, processing, loading providers into the tracking database system to ensure high quality standard are maintained. Credentialing Specialists will assist with audits, provide feedback to reduce errors and improve processes and performance. Works with the Provider Representatives and provider practices to gather documentation required for the Initial and Re-credentialing process. Acts as support to the CVO for the PHSO teams. Responsible for supporting and adhering, to all quality assurance activities that promote company and agency compliance. Identifies and reports on process improvement opportunities to the manager and assists with improving all quality assurance policies and procedures. Actively seeks to model the achievement of excellence. Promotes teamwork by personally adopting principles of caring and integrity. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you'll bring to the team:

• Collects Initial and Re-credentialing applications from provider representatives and provider practices, evaluates them for completeness, and submits to credentialing specialists.
• Supports NCQA audit processes, and ensure all credentialing QA standards and processes are followed.
• Maintains open communication with provider representative, and keeps them informed of the credentialing status of their providers.
• Prepares end of month reports to communicate outcome of credentialing committee meetings and notifies providers of the outcome of their application.
• Assists in mailing initial credentialing applications as authorized by leadership as well as mailing and follow-up re-credentialing applications with providers per timelines specified in PHSO policies and procedures

Qualifications
The expertise and experiences you'll need to succeed:

• Associates degree or 3 years of experience in the field of health insurance (HMO, health insurer, TPA, broker, Quality Assurance, physician practice or healthcare setting) sufficient to yield the knowledge requirements.
• Minimum of five years of professional secretarial, administrative, credentialing, provider network, medical staff facility or provider facility experience.
• Work experience and knowledge of NCQA guidelines
• Working knowledge of typical health plan or Medical Staff Credentialing operations.

---