The Credentialing Representative obtains and reviews documentation to determine status in a health plan. The Credentialing Representative performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.
- The Credentialing Representative reviews the Provider applicant's education, training, clinical privileges, experience, licensure, accreditation, certifications, professional liability insurance, malpractice history and professional competence.
- Make outbound calls and take inbound calls from Providers
- Reviews the information and documentation collected, as well as verification that the information is accurate and complete.
- Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.
- 1 year of job experience in Credentialing, Dental, or Healthcare
- 1 years Customer Service experience .
- Proficiency in all Microsoft Office applications, including Word and Excel
- Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
- Familiarity with medical terminology, credentialing and re-credentialing, and providers process
- High School Diploma or GED
- Designated quiet area to complete calls while working from home
- Must have Internet speed of 25mbps or higher