Highmark · 4 weeks ago
Associate Credentialing Representative
Erie-Meadville Area
Full-time
Onsite
New Grad, Entry Level
$19.27/hr - $26.88/hr
0+ years expHighmark Inc. is seeking an Associate Credentialing Representative to process provider applications and maintain the provider database. The role involves credentialing, re-credentialing, and coordinating credentialing verifications while supporting the implementation of new networks and systems.
Health CareHealth InsuranceInsuranceWellness
Responsibilities
Credential and re-credential providers
Contact providers or representatives by telephone or in writing to obtain additional information while processing their enrollment applications
Screen incoming applications and paperwork for completeness and accuracy and sends necessary paperwork to credentialing vendor
When necessary performs credentialing verifications and loads provider to appropriate networks and credentialing information to the provider database
Manage credentialing inventory, reports and projects to ensure all established time frames for completing work, reports and projects are met
Depending on level, train credentialing team in the use of various systems, software, databases, processes and procedures
Create and distribute monthly reports as assigned and handle complex and unusual or high-level credentialing issues
Support projects, audits, business partners, internal departments and external clients
Represent department as the Subject Matter expert
Pull and research necessary documentation for audits
Support updates necessitated by our business partners, internal departments and external clients
Provide customer oversight for our customers who have unique requirements and timelines to ensure compliance
Depending on level, investigate interim license actions
Participate in projects which streamline, automate, or otherwise enhance credentialing functions
Other duties as assigned or requested
Qualification
Required
High School Diploma or GED
0-1 years of experience
Experience in Provider Data Management, Customer Services or Claims
Microsoft office experience (i.e. Word, Excel, PowerPoint, etc.)
Good written and verbal communication
Proficiency in the use of the Provider file and the credentialing of providers
Proven diplomacy and a professional demeanor for effective communication with provider offices, internal personnel, vendors, accounts and committees
Strong written communication and presentation skills are essential
Preferred
A familiarity with credentialing processes and the URAC standards
Experience in the use of ULTRA and Dental Provider File systems
Experience with the Customer Service inquiry system or claims processing concepts
Company
Highmark
Highmark provides health insurance plans for individuals and businesses.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$27.3M2018-04-06Grant· $25M
2014-08-07Grant· $2.3M
Leadership Team
Deborah Rice-Johnson
CEO, Diversified Businesses at Highmark Inc. and Chief Growth Officer
Paul Sikora
CTO Provider Services
Recent News
2025-12-11
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