- Entry level
- No Education
- Salary to negotiate
The Credentialing Representative obtains and reviews documentation to determine status in a health plan. The Credentialing Representative performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.
The Credentialing Representative reviews the Provider applicant's education, training, clinical privileges, 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. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.
• High School Diploma or equivalent
• 1-2 years of similar job experience (Credentialing, Dental/Healthcare)
• 1-2 Years Excellent Customer Service Skills. Will be making outbound calls and taking inbound calls from Providers
• Proficiency in all Microsoft Office applications, including Word and Excel
• Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
• Familiarity with medical terminology, credentialing and re credentialing providers process
• HS Diploma or equivalent. Associate's or Bachelor's Degree in Business, Finance or a related field preferred
The Company is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.
About the company