Credentialing Specialist

Job Number: 4959

Position Title: Credentialing Specialist

External Description:

We have an immediate opening for a remote Credentialing Specialist to perform the credentialing process on new and current providers in the network by ensuring they are in compliance with current credentialing standards.

Job Responsibilities

• Reviews and processes assigned practitioner and facility files returned from the CVO to ensure consistent documentation and complete verification of provider credentials. Initiate investigation of provider credentials by using on-line primary source verification (PSV) sources, written correspondence and telephone inquiries when necessary. Identify any practitioner not meeting the Credentialing Committee review criteria and prepare administrative items that need Credentialing Committee action. Maintains and updates provider information in the credentialing database to reflect consistent and complete information, and to reflect the recommendations/decisions of Credentialing Committee.
• Ensure applications/re-credentialing applications are processed and reviewed in accordance with NCQA standard time frames. Maintain and update provider information in the credentialing database to reflect consistent and complete information, and the recommendations/decisions of Credentialing Committee.
• Maintain strict confidentiality of all credentialing and Credentialing Committee activities.
• Other responsibilities as assigned.
• Participate in special projects as assigned.

 

Required Experience

• Minimum of 1-3 years of credentialing experience in a health plan, CVO, medical staff office IPA, MSO, or hospital
• primary source verification experience of all required elements i.e., education, work history, Board Certification, license, DEA, sanctions, NPDB
• Familiarity with routine applications software (Microsoft Office) & Internet Resources
• Detail orientated with strong organizational skills
• Ability to research and problem solve
• Ability to manage multiple tasks and prioritize projects
• Ability to work independently and self-motivated
• Good written and verbal communication skills

 

Required Education

High School Diploma/GED

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Credentialing Specialist

Company Profile:

Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

EEO Employer Verbiage:

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster.  If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions.  This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].