Credentialing Specialist II

Job Locations US-CA-Fairfield
Job ID
2024-2876
FLSA Status
Non-Exempt
Hiring Range
$ 27.62 - $ 33.84

Overview

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

Responsibilities

  • Performs, prepares and maintains all credentialing and credentialing activities according to
    policies and procedures. Gathers forms and related documentation and researches
    discrepancies. Scrutinizes documents for consistency and accuracy.
  • Sends forms and related documentation and tracks and follows-up to ensure timely return
    of 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 compiles
    documents.
  • 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 Credentialing
    procedures and accreditation standards.
  • Other duties as assigned.

Qualifications

Education and Experience

High school diploma or equivalent; minimum 18 months credentialing
experience.

 

 

Special Skills, Licenses and Certifications

Strong written and oral communication skills. Advanced computer
skills, including proficiency in multiple software applications including
Microsoft Office. Strong organizational and multi-tasking skills.
Excellent interpersonal and customer service skills. Detail oriented
with ability to recognize vital information. Ability to consistently
maintain quality and production standards. Ability to use good
judgement in making decisions and handle sensitive issues with
diplomacy and tact.

 

 

Performance Based Competencies

Ability to work in a fast paced environment with multiple competing
deadlines. 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.

 

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed