Provider Services - Credentialing Specialist 115-1024

Job Summary

Responsibilities include performing credentialing activities consistently for each applicant in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans of Oklahoma Policy and Procedure Manual.

Key Responsibilities

• Responsible for initial assessment of applications and other data for accuracy and completeness and contacting applicants or other outside resources to resolve questions or to obtain missing information.
• Coordinates the completion of an applicant’s file and review for completeness and accuracy.
• Responsible for entering accurate credentialing elements relevant to each applicant in the database.
• Responsible for monitoring and assessing reports to ensure providers are credentialed in accordance with state mandates, and policy and procedures.
• Responsible for provider file maintenance.
• Perform other duties as assigned.
  
  

Qualifications

• Possess strong oral and written communication skills.
• Basic Medical Terminology preferred
• Ability to interpret and communicate information efficiently and effectively.
• Successful completion of Health Care Sanctions background check.
• Ability to handle multiple tasks and projects simultaneously and strong organizational ability.
• Ability to maintain a positive working environment, project a positive attitude, and be a self-starting individual and maintain a team player attitude.
• Ability to handle confidential information in a professional and sensitive manner.
• Ability to converse and write fluently in English.
  
  

Education/Experience

• High school diploma or equivalent.
• Associates degree OR high school diploma plus two (2) years related healthcare/managed healthcare experience.
• Credentialing experience in a managed care organization or hospital setting preferred.
  
  

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin