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 at http://www.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

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