Credentialing Specialist

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Department: Credentialing & Provider Data Management

Aloha Care’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

Aloha Care’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Credentialing Specialist initiate, maintain and monitor Aloha Care’s credentialing processes to ensure conformance with established department and organizational policy and procedures, national accreditation standards, and contractual state and federal requirements within expected time frames.

• Performs all Aloha Care 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 for contracting purposes.
• Perform verification of credentialing information and complete primary source verification activities as needed.
• Performs internal audits of credentialing file reviews for quality assurance purposes
• Prepares, organizes and maintains assigned credentialing files along with relevant documents to support credentialing processes within expected time frames.
• Assists with coordination and preparation of assigned credentialing files for committee meeting presentation, review and determination.
• Contributes to the development and revisions of applicable workflows and processes to support department and organizational business needs.
• Performs data entry, maintains and monitors credentialing databases to support day-to-day operations of credentialing activities.
• Communicates, both verbally and in writing with providers, administrators and their staff members regarding credentialing activities and processes.
• Assists the Provider Relations, Credentialing and Data Management teams with credentialing inquiries providing responses and resolution in a timely manner.
• Collaborates and communicates with the Provider Relations and Contracts Team relative to Credentialing projects and activities.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as Aloha Care policies and procedures.
• Responsible to maintain confidential information in accordance with Aloha Care policies, state and federal laws, rules and regulations regarding confidentiality. Employees are granted access to Aloha Care’s owned and subcontracts data bases with specific data classifications assigned to this job title.
• Minimum of 1 year of Provider and Facility Health Plan credentialing experience
• Minimum of 1 year of administrative and/or clerical experience
• Minimum of 1 year of customer service experience
• 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; is 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 Power Point
• National certification as credentialing specialist.
• 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: $16.50 - $21.30 an hour