Credentialing Assistant

This is a fully remote position, open to applicants in United States.

📋 Description

• Input reviewer application data and conduct online searches for reviewers.

• Execute primary source verification of board certifications, licenses, background checks, and malpractice investigations.

• Upload documents to electronic reviewer files and create Judgments pages featuring comments from the Medical Director.

• Implement client Do Not Use status and relay application updates to the Operations team.

• Dispatch recredentialing applications to reviewers and escalate any red flags to the Medical Director.

• Examine licenses, certifications, and registrations for expiration dates.

• Generate and receive sanctions clearinghouse reports, investigate flagged sanctions, and gather supporting documentation.

• Forward sanctions and background information to the Medical Director for evaluation.

• Acquire W-9 documents, duplicate profiles after key identifying data changes, and remove reviewers from panels as requested.

• Conduct data entry for new or updated fee schedules and secure fee agreements.

• Attend Quality Management Committee meetings and fulfill follow-up tasks.

• Provide credentialing-related guidance to leadership, contracting, and Operations teams.

• Undertake additional duties and special projects as assigned based on business requirements.

⛳️ Requirements

• Preferred Associate’s Degree or Bachelor’s Degree.

• Preferred credentialing experience in a healthcare or insurance environment.

• Familiarity with URAC and pertinent State and Federal regulations.

• Comprehension of medical terminology.

• Superior communication skills.

• Strong critical-thinking capabilities.

• Proficient time management skills to meet established deadlines.

• Required computer literacy and typing proficiency.

• Capability to perform necessary lifting, bending, traveling, and other physical tasks.

• Ability to endure extended periods of sitting and computer usage.

• Must provide and maintain personal internet services for remote work.

• Must ensure a consistent internet connection.

🏝️ Benefits

• Medical, dental, and vision coverage available for employees and their families.

• Options for voluntary life insurance for employees, spouses, and children.

• Voluntary plans for hospital indemnity, critical illness, accident indemnity, and pet insurance.

• Basic life insurance provided at no cost.

• Short-term disability coverage at no cost.

• Long-term disability coverage at no cost.

• Generous paid time off policy.

• 401k plan with company matching contributions.

• Apple equipment provided for remote work environment.

• Media stipend available for remote workspace.