Overview

To gather and validate healthcare practitioner credentialing information in accordance withregulatory and accreditation standards. Provides administrative support to the CredentialingCommittee. Participates in delegated oversight activities, including ensuring reports anddocumentation are received timely and tracked. The Credentialing Specialist II handles morecomplex transactions and phone calls, additional duties such as meeting minutes, agendas, orassisting with desk procedures, and answers routine questions for Specialists I’s.

Responsibilities

• Performs, prepares and maintains all credentialing and credentialing activities according topolicies and procedures. Gathers forms and related documentation and researchesdiscrepancies. Scrutinizes documents for consistency and accuracy.
• Sends forms and related documentation and tracks and follows-up to ensure timely returnof information.
• Reviews comprehensive written documents and writes concise, accurate summaries.
• Monitors healthcare practitioner licensing boards and federal and state reporting sites.Tracks and reports findings. Conducts primary source verification and compilesdocuments.
• Prepares Committee agendas, meeting minutes, written reports, and related documents.Prepares action items list and monitors to ensure action items are completed.
• Prepares a variety of reports and templates using Word, Excel and Adobe.
• Participates in delegation oversight functions, including report tracking and annual audits.
• Assists with preparing corrective action plans consistent with delegation agreements.
• Educates providers on the completion of forms and required submissions.
• Enters data into several databases.
• Responds to complex telephone inquiries.
• Provides assistance to Credentialing Specialist in the application of Credentialingprocedures and accreditation standards.
• Other duties as assigned.

Qualifications

Education and Experience

High school diploma or equivalent; minimum 18 months credentialingexperience.

Special Skills, Licenses and Certifications

Strong written and oral communication skills. Advanced computerskills, including proficiency in multiple software applications includingMicrosoft Office. Strong organizational and multi-tasking skills.Excellent interpersonal and customer service skills. Detail orientedwith ability to recognize vital information. Ability to consistentlymaintain quality and production standards. Ability to use goodjudgement in making decisions and handle sensitive issues withdiplomacy and tact.

Performance Based Competencies

Ability to work in a fast paced environment with multiple competingdeadlines. Ability to function effectively with frequent interruptions.

Work Environment And Physical Demands

More than 70% of work time is spent using a computer. Ability to lift,carry, or move objects of varying size, weighing up to 25 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 27.62 - $ 33.84

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.