Credentialing Representative - Smithfield, United States - Neighborhood Health Plan of Rhode Island

Neighborhood Health Plan of Rhode Island

Verified Company

Smithfield, United States

1 day ago

Posted by:

Mark Lane

beBee recruiter

Responsibilities include, but are not limited to the following:

Intake of requests for credentialing and re-credentialing and ensure that all applicable documents have been received and initiate outreach to the provider for missing documentation
Manages and prioritizes assigned work to ensure compliance with regulatory requirements and departments goals are met compliance
Conduct monthly checks of, or more often as appropriate, disciplinary action reports issued by State licensure bodies; Medicaid and Medicare exclusion and take appropriate action as defined in policy
Conduct quality onsite assessment at provider offices as assigned
Assist in audits of the Plan by regulatory agencies
Assist in the oversight of delegated credentialing activities
Initiate requests for updates to provider records in claims system when data discrepancies are identified during recredentialing process
Serve as team representative at internal meetings
Maintenance of providers credentialing records between credentialing cycles
Other duties as assigned

Corporate Compliance Responsibility

As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow coworkers, professional affiliates and/or agents

Qualifications

Required:

Associates degree in related field or sufficient work experience to equate to degree
Minimum three (3) years credentialing experience, quality or provider operations
Intermediate knowledge of Microsoft Office, including Outlook, Excel and Word
Able to independently manage multiple tasks at any given time
Excellent verbal and written communication skills in order to communicate inperson or telephonically with applicants, providers, etc.
Ability to effectively communicate interdepartmentally to facilitate work flow
Ability to work collaboratively with peers to support a team environment
Strong attention to details
Excellent organizational skills, including ability to prioritize work and handle multiple tasks simultaneously
Ability to maintain accurate and detailed records
Must be able to readily adjust to change and handle a rapidpaced environment while continuing to provide highquality, efficient service
Adherence to all confidentiality regulations and agreements
Ability to travel. Must have access to reliable transportation. If using a personal vehicle, must have a valid drivers license and proof of insurance

Preferred:

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Ability to learn various software packages as necessary to perform job functions:

Core Company-Wide Competencies:

Job Specific Competencies:

FDR Oversight:

Flexible Work Arrangement:

Telecommuting Arrangement:

Travel Expectations:

N/A
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status._