PacificSource Health Plans

  • Credentialing Assistant

    Job Location US-OR-Eugene
    Job ID
    2018-375
    Type
    Regular Full-Time
    Hiring Pay Range
    $15.00-$17.00
    # of Openings
    1
    Status
    Non-Exempt
  • Overview

    Assist in the credentialing/recredentialing process for practitioners and facilities for network participation. Ensure all credentialing/recredentialing certification processes and procedures are completed in accordance with established regulatory and policy requirements. Coordinate and review all credentialing/recredentialing applications from new and existing providers; complete follow-up and problem resolutions as required. Interpret material received for timeliness and contact individual practitioners or department representatives for necessary information. Coordinate the processing, distribution, and management of all credentialing documents for practitioners insuring the information is verified.

    Responsibilities

    Essential Responsibilities:

    1. Manage receipt of all credentialing/recredentialing applications and enter data into the credentialing database.
    2. Manage monthly recredential mailings and follow-up with practitioners when there is no response.
    3. Facilitate and assist with internal and external record audits as appropriate.
    4. Assist in maintaining a comprehensive database to prepare reports and summaries as appropriate.
    5. Complete other department administrative tasks including: create meeting agendas and prepare minutes, order supplies, assist with provider workshops, and assist with department mailings.
    6. Update provider appointment status from monthly term reports supplied by Operations and run the weekly credentialing report, validate entries and share with Provider Relations/Contracting.

    Supporting Responsibilities:

    1. Assist as backup to the operations department daily support staff during vacation and illness absences.
    2. Assist in delegation data management
    3. Download of electronic credentialing applications from outside entities
    4. Assist in data integrity audits
    5. Meet department and company performance and attendance expectations.
    6. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    7. Perform other duties as assigned.

    Qualifications

    Work Experience: Familiarity of credentialing functions or equivalent experience.

     

    Education, Certificates, Licenses: High school diploma or equivalent required.

     

    Knowledge: A general understanding of credentialing. Proficiency in Word, Excel, Adobe Pro and Access with emphasis on database management. Ability to make administrative and procedural decisions and judgments. Ability to develop and maintain record keeping systems and procedures including maintaining of filing systems. Must be detail oriented with excellent customer service skills.

    Effective written and verbal communications skills and professional telephone skills. Exceptional grammar, spelling, punctuation, consistency, and editing skills. Excellent interpersonal skills.

     

    Competencies

    Our Values

    • Adaptability
    • Building Customer Loyalty
    • Building Strategic Work Relationships
    • Building Trust
    • Continuous Improvement
    • Contributing to Team Success
    • Planning and Organizing
    • Work Standards

     

     

    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers’ experience.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

     

     

    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

     

    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

     

    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

     

    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

     

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