Credentialing Professional

Profile

Description

The Credentialing Professional 2 obtains and reviews documentation to determine status in a health plan. The Credentialing Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Credentialing Professional 2 reviews the applicant's education, training, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence. Reviews the information and documentation collected, as well as verification that the information is accurate and complete. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications


High School Diploma or a related field or equivalent work experience.
Prior work experience in a compliance or auditing function
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Strong written and oral communication skills
Demonstrated attention to detail and accuracy
Proven analytical skills and creative thinker
Demonstrated ability to respond effectively as issues arise
Self-motivated with an ability to manage multiple priorities and work under pressure to meet deadlines
Ability to interact effectively with associates across all levels of the organization
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Dental Credentialing experience required
Use of Sales Force for tracking experience is required
Dental Provider experience is required
Outbound phone calls experience
MS Excel experience and proficiency is required


Preferred Qualifications


Knowledge of state regulations pertaining to compliance in the insurance industry
Minimum 2 - 4 years of healthcare / insurance industry experience
Project Management skills


Scheduled Weekly Hours

40

Company info

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