Associate - Credentialing Specialist

About Capgemini

With more than
180,000 people in over 40 countries, Capgemini is a global leader in
consulting, technology and outsourcing services. The Group reported 2015 global
revenues of EUR 11.9 billion. Together with its clients, Capgemini creates and
delivers business, technology and digital solutions that fit their needs,
enabling them to achieve innovation and competitiveness. A deeply multicultural
organization, Capgemini has developed its own way of working, the Collaborative
Business Experience™, and draws on Rightshore®, its worldwide delivery model.

Learn more about us atwww.capgemini.com.

Rightshore® is a
trademark belonging to Capgemini.

Capgemini is an
Equal Opportunity Employer encouraging diversity in the workplace. All
qualified applicants will receive consideration for employment without regard
to race, national origin, gender identity/expression, age, religion,
disability, sexual orientation, genetics, veteran status, marital status or any
other characteristic protected by law.

This is a general
description of the Duties, Responsibilities and Qualifications required for
this position. Physical, mental, sensory or environmental demands may be
referenced in an attempt to communicate the manner in which this position
traditionally is performed. Whenever necessary to provide individuals with
disabilities an equal employment opportunity, Capgemini will consider
reasonable accommodations that might involve varying job requirements and/or
changing the way this job is performed, provided that such accommodations do
not pose an undue hardship.

Click the following
link for more information on your rights as an Applicant:http://www.capgemini.com/resources/equal-employment-opportunity-is-the-law

Location: Pensacola, FL

JD:

CHCS Services

Job Description

Job Title: Credentialing Specialist

Department: Provider Network

Reports To: Manager, Provider Network

SUMMARY

This position is responsible for processing Provider information for the purpose of evaluating
network acceptance and maintaining current credentials in the designated
computer system.

ESSENTIAL DUTIES AND RESPONSIBILITIESinclude the following.
Other duties may be assigned.

Review credentialing packet and rate amendments for
completeness & document outstanding items.Follow up with providers on outstanding items, both
telephonically and in writing.Select & print appropriate letters requesting additional
information/items.Accurately enter Provider data, including rates, in
designated database systems measured by random supervisory QA review.Accurately document in systems any requests for documents or
information.Complete credentialing process, conduct rate verification per
procedure.Submit complete credentialing packet or rate amendment packet
for Credentialing Committee review & approval.Changes statuses in system, as requested & appropriate.Update expired documentation, in appropriate system, from
automated monthly contact to Providers.Converse with Providers regarding issues &/or rate change
requests, documenting conversations in system.Maintain Provider files by timely filing documents &
following File Maintenance procedures.Prepare & mail Provider application packets as requested
& document system.Follow up with potential Providers in a timely manner.Report any unsolvable Provider issues to Supervisor in a
timely manner.Assist Provider Network Manager & Director in the
recruitment of Providers.Perform on the spot credentialing for John Hancock (Non
Participating Providers) and LTCP (Participating & Non Participating) for
possible referral, rate negotiation and recruitment.Submit all documents into the electronic storage file
database on a ongoing basis. Perform maintenance functions including handling telephone
calls & issue resolution.Provide exceptional customer service to all internal and
external contacts

SUPERVISORY RESPONSIBILITIES

None

QUALIFICATIONS

High school diploma or GED with six month to one-year
previous related experience in a healthcare environment preferred

Typing skills 45 wpm

EDUCATION and/or EXPERIENCE

High school diploma or GED with six month to one-year
previous related experience in a healthcare environment preferred

LANGUAGE SKILLS

English

COMPETENCIES

Customer service skills

Basic knowledge of Windows, Excel, Microsoft Word helpful.

Ability to read and comprehend simple instructions, short
correspondence, and memos.

Ability to write simple correspondence.

Ability to effectively present information in one-on-one and
small group situations to customers, clients, and other employees of the
organization.

Problem-solving skills

MATHEMATICAL SKILLS

Basic Math Skills

REASONING ABILITY

Reasoning skills

CERTIFICATES, LICENSES, REGISTRATIONS

None

PHYSICAL DEMANDS

The physical demands described here are representative of
those that must be met by an employee to successfully perform the essential
functions of this job. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions.

• The noise
level in the work environment is usually moderate.

• The physical
demands include:

o Sitting –
continuous

o Standing –
occasional

o Walking –
occasional

o Lifting -
occasional

WORK ENVIRONMENT

Office Setting