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Corporate Functions & Operations WellCare - Credentialing Careers

Credentialing Specialist Job

Full Job Title: Credentialing Specialist

Job Number: 1805360

Location: Houston, TX

Date Posted: 2018-07-27

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.

Reports To: Manager, Credentialing

Department: Operations

Position Location: Houston, TX 77081

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