Managed Care Credentialing Specialist - Hybrid

MAIN FUNCTION:

Under the direction of the Provider Relations Manager and within established organizational and departmental policies and procedures, responsible for performing a variety of duties including provider enrollment to support the membership operations of CPHO and to coordinate and submit provider applications for credentialing and participation with contracted health plans the Managed Care Credentialing Specialist will also support the Provider Relations Manager in research to bring resolution to provider managed care issues regarding health plan policies and procedures impacting provider enrollment and payment.

MINIMUM REQUIREMENTS:

• Associate degree in business, accounting, finance, or related field; or completion of medical practice management, medical staff coordinator or medical secretary program required.
• Three (3) to five (5) years administrative, medical practice management or medical staff coordinator experience in a health care services organization and understanding of health insurance company operations required.
• Demonstrated autonomy, planning, time management, communication and implementation skills are required to deliver messages to stakeholder that address concerns and correct operations issues.
• Ability to work independently and as part of a team required.
• Demonstrated knowledge of business/financial procedures, an understanding of the organizational structure of PHO’s, hospitals, managed care plans and physician practices and knowledge of managed care contracting principles and terminology required.
• Demonstrated mathematical, computational, and bookkeeping skills and knowledge of financial concepts required.
• Demonstrated superior organizational skills, the ability to manage simultaneous projects and excellent interpersonal and critical thinking skills required.
• Demonstrated proficiency in computer skills required, including word processing, spreadsheet, database such as access, and file maintenance required. .