Job Description:

Under limited supervision of the Managed Care Credentialing Lead, the Managed Care Credentialing Representative II is responsible for meeting with providers to complete all onboarding credentialing application documents and tasks as well as working the application file for committee review in accordance with regulatory standards. The incumbent guides providers through the application and onboarding process, manages application files ensuring all regulatory items are present, and when applicable, recredentials providers in a timely manner.

Essential Job Functions:

Meet with all onboarding providers for application and enrollment navigation and assisting the providers with any questions or concerns.Compiles and maintains current and accurate data for all providers within the credentialing database and credentialing file.Completes provider credentialing and re-credentialing applications; monitors application and follows-up in a timely manner.Responsible for the investigation and documentation of practitioner credentials, utilizing specialized knowledge to obtain verification of all aspects of a practitioner's background, training and past practice.Notifies supervisors and management of adverse or questionable responses from the verification process.Assist providers whom are needing a change in privileges or license type.Maintain department standards while meeting all required regulations.Other duties as assigned

Knowledge, Skills, and Abilities:

Excellent customer service, time management and communication skills (oral and written).Excellent organization skills and attention to detail.Analytical skills and the ability to research industry topics and policies and translate the information into actionable items.Must be able to multitask on various projects while meeting different deadlines 

Experience and Education Qualifications:

High school diploma, GED or equivalent required.Healthcare Credentialing experience required.Experience in healthcare administration utilizing advanced Microsoft Office and excel preferred.

Supervisory Requirements:

None

Employment Requirements:

Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check.Completion of New Hire Orientation at the beginning of employment.All training requirements including Relias at the beginning of employment and annually thereafter.Current driver’s license, acceptable driving record and current auto insurance.

Physical Requirements:

The physical requirements and working conditions described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.While performing the duties of this job, the employee is regularly required to stand and walk and sometimes sit; use hands and arms; and talk or hear.  Prolonged periods of sitting at a desk.The noise level in the work environment is usually moderate. The employee must be able to perform duties, both in office or while working remote and under all weather conditions.

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.

Brightli is a Smoke and Tobacco Free Workplace.