Credentialing Operations Specialist - Temporary

Credentialing Operations Specialist - Temporary Department: Credentialing & Provider Data Management Position Summary: The Credentialing Operations Specialist will be responsible for receiving credentialing applications from all healthcare professionals (physicians, facilities, nursing, allied health, etc.). This includes reviewing applications for completion, verification of state licensure, and collecting information contained in several databases. Maintain credentialing and re-credentialing activities to ensure conformance with established organizational policy and procedures, national accreditation standards, and contractual state and federal requirements. Verify and track the provider’s credentialing data and prepare records as instructed by management. Other clerical duties as assigned. Primary Duties and Responsibilities: Provides support with all AlohaCare credentialing processes and activities to ensure QUEST integration and Advantage Plus (CMS SNP) network adequacy requirements are met which include Individual Providers/Practitioners; Facilities; Long Term Services and Support (LTSS) providers credentialing. Perform triage and validation of credentialing applications and documentation. Process fax received, pick-up mail, scan and enter data for Intake. Ability to work independently to support all aspects of credentialing processes. Verifies provider information to complete primary source verification as needed. Prepares, organizes, and maintains credentialing documents to assist with the credentialing process within specified timeframes. Enters and updates Credentialing system and files. Maintains and monitors credentialing databases for day-to-day operations to support all credentialing activities. Communicates, both verbally and in writing with providers, administrators, and staff members regarding credentialing activities. Assists the Provider Relations, Credentialing Team and Contracts staff with credentialing inquiries providing responses and resolution in a timely manner. All other duties assigned. Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures. Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title. Minimum of 1 year of administrative and/or clerical experience. Minimum of 1 year of customer service experience. Must have the ability to read, analyze, and interpret business documents such as a Credentialing Application. Proficient use and experience with Adobe products and programs. Able to work independently with minimal supervision. Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment. Possesses excellent time management and organizational skills; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure. Data entry experience with a high degree of accuracy and attention to detail. Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint. Provider and Facility Health Plan credentialing experience. May require prolonged sitting- up to 4 hours. Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday. Salary Range: $18.00 an hour Temporary hire through December 31,2026 AlohaCare is committed to providing equal employment opportunities to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders. #J-18808-Ljbffr