Associate - Provider Network

Work
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

I
have reviewed this job description and understand all of the requirements of
performing this job and I am capable of meeting each and every requirement,
with or without reasonable accommodation.
I understand that this job description in no way represents an
exhaustive listing of all tasks involved in performing this job. The job description does not constitute an
employment agreement between employer and employee. I understand that business necessity may
dictate changes in the position requirement at any time. Should I have any questions regarding the
essential functions of my job at any time, I will ask my supervisor immediately
for clarification.