Delegated Credentialing Representative

Job Description

Job Description

Mancan is hiring in Wheeling WV for a Delegated Credentialing Rep! This positon is full time, temp to hire opportunity working Monday-Friday 8am-430pm.

QUALIFICATIONS REQUIRED: (Education, Experience, Skills)
1.Associates Degree or high school diploma/equivalent
2.Strong organizational, interpersonal, and critical thinking skills
3.Excellent communication skills, both written and verbal
4.Ability to multi-task, prioritize workload to meet deadlines, and pay meticulous attention to detail
5.Ability to troubleshoot, problem solve and work as a team as well as indepedently
6.Experience in personal computer software applications such as Microsoft Office (Word, Excel) and Adobe Acrobat

QUALIFICATIONS DESIRED: (Education, Experience, Skills)
1.Bachelors Degree
2.Two years healthcare experience
3.Previous credentialing experience
4.CPCS Certification
5.Experience with data systems
6.Knowledge of medical coding and terminology

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
1.Performs delegated provider credentialing functions
2.Performs initial entry and continuous maintenance of provider record in HEART from delegated provider roster
3.Assists in pre-delegated audits and annual assessment audits to ensure delegated entities compliance in The Health Plan policies and procedures as well as all regulatory/governing entities
4.Assists in preparation for pre-delegated and annual assessment audits including scheduling audits and mailing pre and post audit letters; reporting audit outcomes to management
5.Accurate data entry, document scanning, and navigation of provider data systems
6.Basic pay class assignment/maintenance to ensure accurate claims payment
7.Maintains (termination, edits, loading new information) provider records in HEART with demographic, tax ID, or other changes to ensure accuracy of information
8.Excellent communication and relationship building skills
9.Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities as well as following standards established by NCQA, CMS, BMS, and the states of West Virginia and Ohio
10.Assists with national, state, and internal audits
11.Works collaboratively with the Provider Delivery Services team as well as all internal departments
12.Assists with training and development of new employees related to the delegated credentialing process
13.Researches and resolves internal and external inquiries regarding provider status and system set-up to ensure quality control
14.Maintains confidentiality of provider information

How to Apply:
Visit Mancan Staffing Employment Agency in person during their operating hours:
Address: 1224 Chapline St. Wheeling, WV 26003
Operating Hours: Monday - Friday 9:00 am - 3:00 pm

Required Documents:
When applying in person, please make sure to bring the following documents with you:
-2 forms of government ID
-Resume

For Additional Information:
If you have any further questions or need additional information about the Truck Loader position, feel free to contact Mancan Staffing at View phone number on ziprecruiter.com. Please note that temporary-to-permanent positions are subject to availability, so it's essential to apply promptly and contact Mancan Staffing for the most up-to-date information.

We do offer our temporary employees full benefits such as paid vacation, holidays, 401K, as well as vision/dental/medical. Some of the best companies in the area use Mancan including Fortune 500 companies. It is a great opportunity for you to get your foot in the door with some of the areas top companies.

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