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AlohaCare · 3 weeks ago

Credentialing Specialist

Honolulu, HI

Full-time

Hybrid

Entry Level

$16.50/hr - $21.30/hr

1+ years exp

AlohaCare is a local, non-profit health plan serving Hawai`i’s low-income residents. They are seeking a Credentialing Specialist to initiate, maintain, and monitor credentialing processes to ensure compliance with established policies, accreditation standards, and regulatory requirements.

Health CareHealth DiagnosticsHospitalMedical

Responsibilities

Performs all AlohaCare credentialing processes and activities to ensure QUEST integration and Advantage Plus (CMS SNP) network adequacy requirements are met which include Individual Providers/Practitioners; Facilities; Long Term Services and Support (LTSS) providers credentialing for contracting purposes

Perform verification of credentialing information and complete primary source verification activities as needed

Performs internal audits of credentialing file reviews for quality assurance purposes

Prepares, organizes and maintains assigned credentialing files along with relevant documents to support credentialing processes within expected timeframes

Assists with coordination and preparation of assigned credentialing files for committee meeting presentation, review and determination

Contributes to the development and revisions of applicable workflows and processes to support department and organizational business needs

Performs data entry, maintains and monitors credentialing databases to support day-to-day operations of credentialing activities

Communicates, both verbally and in writing with providers, administrators and their staff members regarding credentialing activities and processes

Assists the Provider Relations, Credentialing and Data Management teams with credentialing inquiries providing responses and resolution in a timely manner

Collaborates and communicates with the Provider Relations and Contracts Team relative to Credentialing projects and activities

All other duties assigned

Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures

Responsible to maintain confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees are granted access to AlohaCare’s owned and subcontracts data bases with specific data classifications assigned to this job title

Qualification

Credentialing experienceData entry accuracyMicrosoft OfficeCustomer service skillsProfessional etiquetteInterpersonal skillsProblem-solving skillsTime managementWritten communicationOral communication

Required

High school diploma or equivalent

Minimum of 1 year of Provider and Facility Health Plan credentialing experience

Minimum of 1 year of administrative and/or clerical experience

Minimum of 1 year of customer service experience

Achieves results, builds trust, communicate effectively, customer and quality focused

Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization

Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations

Professional telephonic etiquette skills

Ability to solve problems, analyze, think critically and make good judgment

Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills

Able to work independently with minimal supervision

Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment

Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure

Data entry experience with a high degree of accuracy and attention to detail

Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint

Experience in the operation of general office equipment to include PC, fax/copy machine and phone system