Credentialing Operations Specialist

2 days ago


Honolulu HI United States AlohaCare Full time

Are you ready for new challenges and new opportunities?

Join our team

Department: Credentialing & Provider Data Management

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication, and a generous benefits package.

Position Summary:

The Credentialing Operations Specialist will be responsible for receiving credentialing applications from all healthcare professionals (physicians, facilities, nursing, allied health etc.). This includes reviewing applications for completion, verification of state licensure, and collecting information contained in several databases. Maintain credentialing and re-credentialing activities to ensure conformance with established organizational policy and procedures, national accreditation standards, and contractual state and federal requirements.

Primary Duties & Responsibilities:

  • Provides support with all AlohaCare credentialing processes and activities to ensure QUEST integration and Advantage Plus (CMS SNP) network adequacy requirements are met.
  • Performs triage and validation of credentialing applications and documentation.
  • Process fax received, pick-up mail, scan and data enter to Intake.
  • Ability to work independently to support all aspects of credentialing processes.
  • Verifies provider information to complete primary source verification as needed.
  • Prepares, organizes, and maintains credentialing documents to assist with credentialing process within specified timeframes.
  • Enters and updates Credentialing system and files.
  • Maintains and monitors credentialing database for day-to-day operations to support all credentialing activities.
  • Communicates, both verbally and in writing with providers, administrators, and staff members regarding credentialing activities.
  • Assists the Provider Relations, Credentialing Team and Contracts staff with credentialing inquiries providing responses and resolution in a timely manner.
  • Responsible for maintaining confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality.

Required Competencies & Qualifications:

  • High School Diploma
  • Minimum of one year of administrative and/or clerical experience
  • Minimum of one year of customer service experience
  • Strong verbal and written communication skills
  • Proficient in Microsoft Office products; Word, Excel, Outlook, and Power Point
  • Proficient use and experience with Adobe products and programs
  • Excellent attention to detail
  • Problem solving and active hearing and listening skills a must.
  • Ability to multi-task, handling varied responsibilities daily.
  • Ability to prioritize and organize daily activities.
  • Type 40 words a minute and 10 Key by touch
  • Strong interpersonal and customer service skills
  • Flexibility and adaptability to changing priorities.

Preferred Competencies & Qualifications:

  • Provider and Facility Health Plan credentialing experience (Highly desirable)

Physical Demands/Working Conditions:

  • Operation of computer workstation, including keyboard and video display terminal.
  • Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.

Salary Range: $16.50 - $20.00 an hour

AlohaCare is committed to providing equal employment opportunities to all applicants in accordance with sound practices and federal and state laws.

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