Job Information
Independent Health Credentialing Specialist in United States
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Overview
The Credentialing Specialist will be responsible for maintaining the timely and accurate credentialing and re-credentialing of all Independent Health providers. Responsibilities include the management of provider files and documentation in adherence with regulatory requirements and Independent Health policies. The credentials specialist is expected to work with internal departments to ensure the accuracy of the provider data and provide effective, professional external customer service. The specialist will be responsible for maintaining all work through the Healthrules system.
Qualifications
High School diploma or GED required; Associates Degree preferred.
Two (2) years of healthcare operations experience required. Credentialing experience preferred.
Demonstrated experience in Windows and Microsoft Word. Knowledge of HealthRules and Visual Cactus preferred.
Excellent organizational and time management skills with ability to prioritize work according to established deadlines. Must be able to manage multiple projects.
Ability to work independently owning a process from start to finish while under strict deadlines and decision-making skills commensurate with position responsibilities.
Excellent written and verbal communication skills; demonstrated ability to communicate with physicians and health care providers; excellent customer service skills.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Processing:
Input provider applications into credentialing database and process within required time frame. Ensure that all applications are complete and accurate and in compliance with NCQA, DOH, and CMS standards as well as Independent Health’s policy requirements.
Complete and close clean, routine applications within required time frame.
Initiate credentialing packets as assigned and scheduled.
Perform tracking and process to maintain compliance with Federal, State, NCQA, and internal requirements.
Initiate follow-up and action on any conflicting or incomplete information.
Complete and close assigned recredential files with required time frame.
Review and edit file for completeness and accuracy, meeting all regulatory requirements before turning in for analyst review.
Maintain Network Evaluation process and profiles for physician network. Gather and document information from respective departments and ensure profiles are complete for recredentialing review.
Primary Source Verification:
Perform primary source verification utilizing the credentialing software package according to IPA/WNY policies and procedures.
Query primary sources by letter or phone for verification of provided information.
Initiate additional request when response is not received within required time frames.
Query data bases and utilize internet sources available for verification of license, board information, sanctions, and claims history.
Maintenance:
Maintain the credentialing data base and provider hard copy file.
Enter all noted changes and update provider credentialing data base record, as applicable in both Cactus and Health Rules.
Remain current and informed on credentialing policies and procedures.
Reporting:
Generate routine reports as required from the system.
Provide manager with status report of assigned files at month end.
Generate reports required for follow-up as needed.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $20.00 - $23.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here (http://www.independenthealth.com/about/careers/additional-eeo-aap-information) for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.
Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community.
We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog.
We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here (http://www.independenthealth.com/about/community-report) to view our Community Reports.
Apply today and join us on the journey to a happier, healthier, and more inclusive community.
We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.
Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.