Position Purpose
Coordinates and oversees the delegated credentialing process for all practitioners and providers within the network. Serves as a back up for the non-delegated credentialing process for all practitioners and providers in the network.
Essential Position Functions
- Oversee and administer the delegated credentialing program.
- Communicate effectively with outside provider, CAQH, regarding provider credentialing and recredentialing needs.
- Ensure all providers are credentialed and re-credentialed on a timely basis.
- Maintain credentialing databases.
- Data collection, entry and verification for all provider directory data.
- Generate credentialing reports.
- Assist with gathering information for credentialing committee.
- Apply federal and state guidelines that address credentialing and re-credentialing processes.
- Follow NCQA credentialing guidelines.
- Communicate with providers and practitioners with exceptional customer service skills to fulfill the credentialing requirements.
- Assist with provider mailings.
- Assist with annual audit functions for delegated providers
- Ensure delegated providers are providing reports as required.
- Communicate effectively with Provider Relations and Credentialing team.
- Other job-related duties as may be necessary to carry out the responsibilities of this position.
Minimum Requirements of the Position
- High school graduate or equivalent.
- Knowledge of medical terminology and managed health care is desirable.
- High level of proficiency in Microsoft Access, Word, Excel and Internet navigation.
- Excellent interpersonal, communication, writing, organizational, project management, and math skills.
- Ability to work in a fast-paced work environment and meet deadlines.
- Knowledge of medical terminology is beneficial.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.