Primary Function

Under the direction of the Credentialing Supervisor, the Payer Credentialing Associate performs various credentialing research as well as clerical and office functions. Duties include but are not limited to data entry, and telephone calls to insurance payers, providers, and/or others for the purpose of accurate and timely information and processing. Other duties as necessary to assist the Credentialing Department to help with the facilitation of the payer credentialing process. The Payer Credentialing Associate functions as a liaison to coworkers, and internal and external customers to ensure appropriate and adequate support for the many functions performed within the Credentialing Department.

Specifications

• High school graduate or equivalent required.
• 1-3 years of prior experience in a healthcare or business setting preferred.
• Must be organized, detail-oriented, and possess the ability to follow directions.
• Must have exceptional interpersonal skills, telephone etiquette, and written communication skills.
• Computer experience with Microsoft Office products including Word, Outlook, and Excel is required.

Responsibilities

• Work in conjunction with the credentialing team responsible for providing clerical assistance to the team as needed for daily, weekly duties, and other projects as assigned by the Credentialing Supervisor.
• Assist with the maintenance and updating of the CAQH database and internal database MSOW, as necessary for processing applications and to assure Data Directory is maintained per CMS guidelines.
• Respond to emails, telephone calls, and correspondence daily in accordance with department policy and procedures.
• Develop and maintain relationships with key contacts such as payers and internal departments.
• Document and resolve issues promptly, consistent with established department standards.
• Collaborate and effectively perform special payer research and/or projects as requested.
• Preserve and protect providers’ information and privacy.
• Perform other related duties as requested.