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Corporate Functions & Operations WellCare - Credentialing Careers

Credentialing Specialist Job

Full Job Title: Credentialing Specialist

Job Number: 1706103

Location: Tampa, FL

Date Posted: 1-4-2018

Provider, Facility and Ancillary credentialing, to include all aspects of new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; online verifications; administrative support of credentialing functions.

Essential Functions:
  • Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing processing.
  • Perform all required primary source verifications.
  • Contact hospitals, licensing agencies, malpractice carriers, and medical schools to obtain credentialing verifications.
  • Maintain and update credentialing database records.
  • Review malpractice history, regulatory and disciplinary action reports issued by state and federal agencies invoking appropriate processes as defined in policies and procedures.
  • Review the CAQH system and download applications or supplemental documents as appropriate.
  • Maintain electronic provider files.
  • Perform outreach to providers and facilities via phone calls and fax/email correspondence.
  • Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.).
  • Perform other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Required 2 years of experience in a customer service or healthcare related position
  • Preferred 1 year of experience in Credentialing
Candidate Skills:
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to work as part of a team
  • Intermediate Ability to effectively present information and respond to questions from peers and management
  • Intermediate Other Knowledge of credentialing software sufficient to develop appropriate reports on all aspects of credentialing
Licenses and Certifications:
A license in one of the following is required:
  • Preferred Other Certified provider credentialing specialist or directly related or equivalent work experience
Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Other Ability to learn various software packages as may be necessary to perform job functions

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Last Updated On: 12/9/2015