The Credentialing Specialist is responsible for processing credentialing and re-credentialing applications in accordance with department expectations, credentialing policies and procedures and regulatory requirements. Works closely with internal and external customers, ensuring the credentialing process is completed correctly, within established timeframes.
- Reviews applications for completeness, identifying discrepancies and potential issues.
- Conducts verifications and queries as required by regulatory standards and departmental policies and procedures.
- Responsible for timely and accurate multi-system data entry of provider additions, deletions and changes in accordance with departmental policies and procedures.
- Maintains a working knowledge of contracting policies, procedures and processes, in an effort to provide cross-functional support to the contract services team on an as-needed basis.
- Prepares and distributes reports in accordance with departmental procedures.
- Assists in Credentialing Committee preparation, records minutes and promptly performs follow up actions as requested by Committee members as needed.
- Meets or exceeds departmental timeframes and quality metrics on a consistent basis.
- Maintains knowledge of credentialing policies and procedures and NCQA, URAC and CMS regulatory requirements.
- Performs all other related duties as assigned
recognized for your performance in an environment that will challenge you and
give you clear direction on what it takes to succeed in your role as well as
provide development for other roles you may be interested in.
- High School diploma or GED
- One or more years of administrative, database and / or data entry experience in credentialing or in a managed health care setting or related environment.
- Must be able to maintain confidentiality while working with sensitive information.
- Must be detail-oriented, well-organized and have the ability to multi-task effectively.
- CPCS certification or willingness to pursue certification.
- More than one year experience in managed care credentialing.
- Knowledge of Microsoft Office software applications (Word, Excel and Access)
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords : Reimbursement, provider networks, San Antonio, TX, Texas