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Corporate Functions & Operations WellCare - Credentialing Careers

Credentialing Specialist - Senior Job

Full Job Title: Credentialing Specialist, Senior

Job Number: 1803857

Location: Phoenix, AZ

Date Posted: 6-8-2018

Provider, Facility and Ancillary credentialing, to include all aspects of the new applicant credentialing, re-credentialing; ongoing maintenance of provider credentials; report preparation, online verifications; administrative support of credentialing functions; assist in training new associates.

DEPARTMENT: Provider Relations

REPORTS TO: Director, Quality Improvement

Location: Phoenix, AZ

Essential Functions:

  • Review new applications and supporting documents in a virtual environment and apply policy and criteria required for credentialing process.
  • May perform required primary source verifications.
  • Perform outreach to providers, licensure bodies and governmental agencies via phone, fax or written correspondence.
  • Maintain and update credentialing database and core system records.
  • Review monthly, or more often as appropriate, regulatory and disciplinary action reports issued by State licensure agencies, Federal and State authorities and the Office of Inspector General; identify affected providers and invoke the appropriate process as defined in policy and procedure.
  • Maintain regulatory reports of provider sanctions and terminations.
  • Review cases requesting termination, reinstatement or specialty changes and apply policy and criteria required for processing.
  • Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc..).
  • Perform other duties as assigned.
Candidate Education:
  • High School or GED
Candidate Experience:
  • 4 years of experience in a customer service or healthcare related position
  • 1 year of experience in Credentialing
Candidate Skills:
  • Demonstrated written communication skills
  • Demonstrated interpersonal/verbal communication skills
  • Ability to work as part of a team
  • Ability to move around office, use a telephone, computer, monitor, keypad and mouse
  • Ability to effectively communicate interdepartmentally to facilitate work flow
  • Ability sit for periods of up to 3 hours

Licenses and Certifications:
A license in one of the following is required:

  • Certified Provider Credentialing Specialist

Technical Skills:

  • Microsoft Word
  • Microsoft Excel
  • Microsoft Outlook
  • Ability to learn various software packages as may be necessary to perform job functions

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Last Updated On: 12/9/2015