Credentialing Specialist - Alpharetta - Winmax Systems

    Winmax Systems
    Winmax Systems Alpharetta

    3 hours ago

    Description
    Title: Credentialing Specialist

    Location: Alpharetta, GA

    Contract: 12+ Month

    Job Description:

    * Screens provider credentialing and re-credentialing packets for missing information; requests missing information from provider; resolves discrepancies between information supplied and findings of other sources (State Dental or etc.);
    * Creates and updates provider information in the credentialing system to ensure that credentials are completed within a timely manner and at a high level of accuracy.
    * Receives provider inquiries via phone and correspondence. Researches and verifies detailed information on provider participation status. Perform verification of all applicable credentials.
    * Contact providers for missing and expired information.
    * Processing mail; incoming and outgoing.
    * Performs miscellaneous duties as assigned.

    Skills/Experience:
    Job Requirements:

    * A high school diploma or GED is preferred, but candidates with proven experience will not be excluded from consideration.
    * A minimum of 2 years related experience.
    * Knowledge of Delta Dental products, policies and terms of provider participation in various networks is expected at conclusion of training and any applicable probationary period.
    * Ability to maintain confidentiality of providers information.
    * Demonstrated understanding of basic corporate structures and how to accurately translate information provided on contracts, credentialing attestations and other sources to maintain provider records.
    * Math skills to compile and validate statistical computations, reconcile discrepancies, and insure the validity and accuracy of results.
    * Knowledge and application of English grammar including composition, editing and proofreading skills.
    * Basic organizational/time management and project management skills and multi-tasking abilities.
    * Detail oriented with analytical and problem solving skills. Knowledge of health care industry issues preferred.
    * Ability to accurately enter relevant information into the credentialing system and other ancillary data repositories as needed.
    * Must be able to understand fairly complex written and oral instructions.
    * Ability to clearly present written information and findings. Ability to communicate concepts.
    * Ability to interact well with co-workers and outside contacts.
    * PC literacy; MSOffice skills (competency in Word, advanced skill in Excel, Access and other database applications).
    * Regularly required to work standard office equipment (personal computer, photocopy machine, fax machine, etc.).
    * Ability to work on a computer up to 7 hours a day.
    * Regularly required to sit for long periods of time, and occasionally stand and walk.
    * Regularly required to use hands to operate computer and other office equipment.
    * Close vision required for computer usage. Occasionally required to stoop, kneel, climb and lift up to 25 pounds.

    Required Skills:
    Shift: 8:00am-4:45pm EST (could start as late as 9am if needed)
    Resource will be working off of their own personal equipment. (no MacBook/no Chromebook)
    Resource must be local to the Alpharetta, GA or Camp Hill, PA office. Though the role is remote, the is a potential opportunity to go onsite at a future time.

    Notes on what the Manager is looking for in the applicants experience:
    - High attention to detail working in a production environment
    - Strong data entry skills
    - Must have experience working in the healthcare/dental/insurance industry
    - Resource MUST have two monitors to be successful in this position
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Credentialing specialist