Credentialing Operations Specialist

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication, and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect, and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

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, 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 provider credentialing data and prepare records as instructed by management. Other clerical duties as assigned.

Primary Duties & 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.
• Performs triage and validation of credentialing applications and documentation.
• Process fax received, pick-up mail, scan and data enter to 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 credentialing process within specified timeframes.
• Enters and updates Credentialing system and files.
• Maintains and monitors credentialing database 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.
• Responsible for maintaining confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees are granted access to AlohaCare’s owned and subcontracts data bases with specific data classifications assigned to this job title.

Other credentialing duties as assigned to support department business needs.

• Complete other tasks as assigned.

Required Competencies & Qualifications:

• High School Diploma
• Minimum of one year of administrative and/or clerical experience
• Minimum of one year of customer service experience
• Strong verbal and written communication skills
• Proficient in Microsoft Office products; Word, Excel, Outlook, and Power Point
• Proficient use and experience with Adobe products and programs
• Excellent attention to detail
• Problem solving and active hearing and listening skills a must.
• Ability to multi-task, handling varied responsibilities daily.
• Ability to prioritize and organize daily activities.
• Type 40 words a minute and 10 Key by touch
• Strong interpersonal and customer service skills
• Flexibility and adaptability to changing priorities.
• Must have the ability to read, analyze, and interpret business documents such as a Credentialing Application.

Preferred Competencies & Qualifications:

• Provider and Facility Health Plan credentialing experience (Highly desirable)

Physical Demands/Working Conditions:

• Operation of computer workstation, including keyboard and video display terminal.
• Operation of office equipment, mitel phone system, efax, Xerox printer/copy machine.
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Salary Range: $16.50 - $20.00 an hour

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/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

Salary : $17 - $20