Credentialing Specialist

🔥 14 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

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American Health Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1976

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

American Health Partners is a healthcare organization focused on improving access to and coordination of high-quality care through a continuum of services tailored to institutional and special-needs populations. The company operates institutional special needs health plans and provides specialized care coordination, geriatric inpatient and acute psychiatric care, and pharmacy services for long-term-care facilities, supported by an owned/affiliated network of locations and thousands of contracted providers. American Health Partners emphasizes convenient, preventive care to reduce costly hospital stays and improve patient outcomes and quality of life.

📋 Description

• Maintain and load provider demographic information received via contracts, roster updates, and/or applications to the CVO • Review data and correct detected errors • Keep information current and remain within departmental standards • Extract and report data for analyses • Help maintain database integrity and quality assurance • Contact providers to obtain missing or incorrect documentation and follow up as necessary • Participate in calls with network services staff to troubleshoot and recommend program enhancements • Assist with the Credentialing Committee approval and denial notification process, including welcome and denial letters • Complete corporate assignments and other duties as assigned • Work with multiple departments and the CVO to ensure contracted providers meet qualifications • Support reporting functions of provider data to agencies, committees, and management

🎯 Requirements

• High school diploma or equivalent required • Post-secondary education preferred • Previous experience in the healthcare field required • Prior credentialing experience • Prior experience with CVO platforms strongly preferred • Prior experience in network services data management preferred • Prior experience with Medicare Advantage plans preferred • CMS reporting provider and data reporting experience preferred • Fluent in all provider types, affiliations and relationships • Proficient computer skills • Ability to accurately enter data into information systems • Ability to prioritize workload and adjust to a changing environment • Effective written and spoken communication skills • Ability to handle multiple priorities, multitask, and meet deadlines • Ability to work independently and accept instructions • Travel may be required to come into the corporate office if located within 40 miles

🏖️ Benefits

• Affordable Medical/Dental/Vision insurance options • Generous paid time-off program and paid holidays for full time staff • TeleDoc 24/7/365 access to doctors • Optional short- and long-term disability plans • Employee Assistance Plan (EAP) • 401K retirement accounts with company match • Employee Referral Bonus Program • Remote work from home in a dedicated office space • Flexible hours may be available

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