Credentialing Specialist

Multiplan Inc. Chattanooga , TN 37402

Posted 2 months ago

Job Description:

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

Because our Bedford, MA office is closed for the time being due to the pandemic, you will work from home until the office reopens. Once the office reopens, you will work in the Bedford, MA office each day.

JOB SUMMARY: Supports the Appeals Committee, Credentialing Committee, credentialing and recredentialing programs. Apply team support, and monitoring of the workflow pertaining to the Appeals and Credentialing Committee.

JOB ROLES AND RESPONSIBILITIES:

1.Coordinates all practitioner appeals with internal and external representatives

2.Maintain practitioner files with varying levels of appeal

3.Assembles and distributes internal and external correspondence regarding Credentialing Committee decisions

4.Effectively communicate and educate practitioners and internal departments regarding Credentialing Committee decisions

5.Contact practitioner offices to obtain additional information

6.Collects, researches and redistributes undeliverable certified mail

7.Performs all other duties and responsibilities deemed necessary

8.Ensure systematic data oriented efforts to improve consumer and/or client services. 100% of this job is related to QM activities.

9.Collaborate, coordinate, and communicate across disciplines and departments.



  1. Ensure compliance with HIPAA regulations and requirements.

  2. Demonstrate commitment to the Company's core values.

  3. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.


JOB SCOPE:

The incumbent is an entry-level position within the Credentialing Specialist job family and works under indirect supervision. The incumbent uses independent judgment and knowledge of policies, practices, and procedures within the field to complete job responsibilities and may require a moderate amount of oversight and direction from management or senior associates in day-to-day tasks and duties. The incumbent refers more complex issues to higher levels. 100% of overall responsibilities that are dedicated to QM functions and include the scope of responsibilities related to QM function.

Note: This position cannot be located in Colorado.

Job Requirements

  • Minimum Associates Degree or 2 years of related experience

  • Minimum 3 years of credentialing experience

  • Knowledge of NCQA and URAC accreditation standards required

  • Required licensures, professional certifications, and/or Board certifications as applicable

  • Communication (written, verbal and listening), problem solving, organizational and interpersonal skills

  • Ability to be service oriented and flexible.

  • Ability to work under pressure

  • Ability to work independently, effectively and well in both individual and team environments

  • Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, Microsoft Word and Excel, etc.

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

  • Medical, dental and vision coverage (low copay & deductible

  • Life insurance

  • Short- and long-term disability

  • 401(k) + match

  • Generous Paid Time Off

  • Paid company holidays

  • Tuition reimbursement

  • Flexible Spending Account

  • Employee Assistance Program

  • Summer Hours

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you'd like more information on your EEO rights under the law, please [ Link Removed ] .

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Continuous Improvement Specialist

Covenant Logistics Group

Posted 7 days ago

VIEW JOBS 10/15/2021 12:00:00 AM 2022-01-13T00:00 <p>The Continuous Improvement Specialist assists in the evaluation of current business practices; helps lead change initiatives within the organization; actively engages functional business units to standardize processes and improve functionality; and aids in the overall execution of the Continuous Improvement strategy to deliver quantified results. </p><ul> <li>Support all planning activities, customer and internal schedules, coordination of roles for Warehouse startups</li> <li>Oversees any warehouse projects -either operational or technical -that arise from new business or legacy business; tracks and provides regular project status updates and audit reports</li> <li>Manage the risk, issue and change resolution process for warehouse startups and projects; work with applicable stakeholders to take corrective action as needed</li> <li>Interface with Executive and Sr. level leadership to define warehouse project priorities and implementation opportunities and challenges, and keep them up-to-date with project risks and opportunities </li> <li>Acts as a strategic advisor to VP of Warehouse Operations </li> <li>Engage and support the planned review of process improvements and organizational activities to foster a culture of sustainable Continuous Improvement</li> <li>Continuous Improvement and cost reduction projects that support enterprise objectives </li> <li>Identify areas for process improvement and drive necessary change using Continuous Improvement methodology, including Lean &amp; Six Sigma</li> <li>Maintain a strong portfolio of improvement projects; leader must maintain project deadlines, communication and resource commitments </li> <li>Collect, organize and distribute data to help prioritize projects, quantify returns on </li> <li>investment and other improvements and provide data regarding process performances </li> <li>Provide oversight and training related to Continuous Improvement tools and methods</li> <li>Routinely complete process reviews and document through SOPs, Work Instructions, and or Process Maps</li> <li>Analyze flow of people, activities, materials, work methods, policies &amp; procedures, technology and supervisory structure to support improvement objectives</li> <li>Assist functional business units through measuring and monitoring of production activities, data analysis, trend identification and establishment of projects that drive improvement </li> <li>Employee may perform other related duties as required to meet the ongoing needs of Covenant Logistics</li> </ul><p><br></p><p><br></p><p><strong>Requirements</strong></p><ul> <li>Must have the ability to communicate effectively in verbally, in written form, and electronically</li> <li>Must have the ability think quickly and make sound, confident decisions</li> <li>Ability to work independently with a high degree of initiative, attention to detail, and follow through, or perform effectively as part of a team </li> <li>Must have the ability to work under pressure, meet tight deadlines, successfully multi-task while </li> <li>maintaining organization and respond positively to constructive criticism</li> <li>Strong desire to exceed expectations through difficult challenges, coupled with the ability to remain positive and solution focused</li> <li>Strong and diverse change management skills</li> <li>Strong project management skills and ability to execute projects successfully with verified results</li> </ul><ul> <li>Bachelor’s Degree in Business Administration, Technology or related field</li> <li>Master’s degree preferred</li> <li>Project Management Professional (PMO) preferred</li> <li>2+ PMO experience in service/logistics</li> <li>1+ years of direct Continuous Improvement experience with a proven track record of excellence</li> <li>1+ of professional experience in a leadership capacity</li> </ul><p><strong>Benefits</strong></p><p>Competitive Compensation</p><ul><li>401(k) match, Serious Health Condition Pay</li></ul><p>Full Health Benefits Package</p><ul><li>Medical, Dental, Vision, Telemedicine, Short &amp; Long Term Disability, Health Savings Account, Life Insurance</li></ul><p>Paid Time Off</p><ul><li>Holidays, Birthday, Wellness Day, Vacation &amp; Sick Time</li></ul><p>Cultural Perks</p><ul><li>Casual Dress, Tuition Reimbursement, Employee Discount Program, Dependent Care Flexible Spending Account, Adoption Assistance and Employee Assistance Program</li></ul><p>Covenant Logistics is an Equal Opportunity Employer<br>M/F/Disability/Veteran<br></p><p>VEVRAA Federal Contractor</p> Covenant Logistics Group Chattanooga TN

Credentialing Specialist

Multiplan Inc.