Ancillary Credentialing Rep

Responsibilities

• Daily monitoring of application status and documents progress to ensure compliance
• Reviews and processes ancillary initial credentialing and recredentialing applications and supporting documentation to identify possible issues
• Follows up with responsible parties to obtain missing information
• Ensures recredentialing applications are completed timely to prevent any lapse in participation
• Identifies credentialing applications with variances and complies information for management review
• Accurate data entry, document scanning, and navigation of provider data systems
• Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities as well as following standards established by NCQA, CMS, BMS, and the states of West Virginia and Ohio
• Assists with national, state, and internal audits
• Works collaboratively with the Provider Delivery Services team as well as all internal departments
• Manages credentialing application volume
• Assists with training and development of employees related to the ancillary credentialing process
• Maintains confidentiality of provider information
• Enters newly contracted ancillary providers into HEART to ensure correct claims payment
• Maintains participating facility records in symplr Payer and the claims operating system with demographic, Tax ID, or other changes to ensure data accuracy

Requirements

• Associate's degree or equivalent
• Two years related healthcare experience
• Strong organizational, interpersonal, and critical thinking skills
• Excellent communication skills, both written and verbal
• Ability to multi-task, prioritize workload to meet deadlines, and pay meticulous attention to detail
• Ability to troubleshoot, problem solve and work as a team as well as independently
• Experience in personal computer software applications such as Microsoft Office (Word, Excel) and Adobe Acrobat