We have an opportunity to join the Alliance as a Provider Services Credentialing Specialist (overseeing/leading/in) the (name) Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

• Conducting provider credentialing and re-credentialing, including performing Primary Source Verifications
• Researching and analyzing complex credentialing issues and developing and proposing solutions
• Performing and monitoring of physician license status and state and federal sanctions of contracted and non-contracted providers and conducting related investigations

Performs other duties as assigned

ABOUT THE TEAM

Provider Services works with our providers as a partner in giving high-quality, safe and compassionate care to our members.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here

• Knowledge of:
  
  • Healthcare terminology
  • Methods and techniques of research, analysis and reporting
  • Methods and techniques of data entry and data auditing
  • Principles and practices of customer service
  • Some knowledge of managed care concepts
  • Some knowledge of the basic principles and practices of project management
• Ability to:
  • Interpret, explain and apply policies, procedures, laws, regulations and contract language
  • Identify and troubleshoot issues, gather and analyze information and data, identify alternative solutions and make recommendations for action
  • Enter, proofread, verify, analyze and audit data, and identify data anomalies
  • Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines
  • Assist with the development and maintenance of workflows, work instructions, policies and procedures
  • Quickly become familiar with providers and credentialing activities in assigned counties.
• Education and Experience:
  • Bachelor’s degree in Business or Public Administration, Public Policy, Health Care or a related field and a minimum of three years of experience performing credentialing, compliance or other regulatory functions in a healthcare or government setting (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER DETAILS

• While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
• Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
• Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).