Summary: Under the direct supervision of Vice President, Provider Relations, and with general responsibility to the Provider Relations division, this position is responsible for accurate and timely provider (re)credentialing support, and computerized file maintenance.
Under the general direction and guidance of the Director, Provider Relations and through specific direction provided by the person for whom work is performed:
- Research and resolve claims and the related issues as requested by Claims Administration.
- Enter Case Specific Agreements into MCS.
- Enter Referral Agreements into MCS.
- Initiate (re)credentialing process upon receipt of application. Review provider and primary source responses. Refer all responses not meeting BHS credentialing criteria to Vice President, Provider Relations.
- Maintain computerized provider system, including preparing data conversions for network providers, and entering current credentialing/quality assurance information.
- Work with Network Development/Clinical/Claims Administration whenever they have questions regarding claims and need information and assistance in getting the claims entered and/or approved.
- Act as the primary liaison between Credentialing and other divisions within the company whenever there are questions to include responding to or routing emails and/or phone calls to the appropriate parties, researching and/or resolving provider credentialing-related issues, and managing tasks submitted through internal provider management system.
- Learn all other Credentialing Specialist job duties.
- Prepare reports as requested.
- Attend quarterly credentialing committee meetings, as requested.
- Maintain all information in a confidential manner.
- Adhere to established policies and procedures as directed.
- Perform other related duties and special projects as directed.
- High school diploma, some college preferred
- 3 years extensive data entry experience
- Minimum 60 WPM typing
- Proficiency in MS Word and Access required
- Advanced PC computer software skills (i.e., spread sheets, special programs)
- Familiarity with internet
- Accuracy and attention to detail
- Excellent proofreading skills
- Good organization and written communication skills
- Ability to meet deadlines/handle interruptions/problem-solve
- Cooperative attitude and self-starter
- Superior disposition and telephone communication skills
- Dependability and punctuality
- Ability to work with a minimum of supervision
- Alabama driver’s license and dependable transportation
- Provider credentialing or provider systems experience (or related provider relations experience) required