Credentialing Specialist

Job Number: 4959

Workplace Type: Fully Remote

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 is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*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].