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Business Professional Job In Atlanta, Georgia

CREDENTIALING SPECIALIST II

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By clicking "Apply Now" you will be redirected to the employer's webpage to complete the application.
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Company: JobTarget Profession/Specialty: Business Professional Location: Atlanta, Georgia 30303
Job Description

Location
GA: Atlanta

Job Family
Network Contracting/Provider Relations


Job Brief

Credentialing Specialist II will be responsible for credentialing and re-credentialing of behavioral health providers and facility organizations (hospitals, mental health centers, etc

ABOUT THE POSITION

We are currently seeking a dynamic Credentialing Specialist II to join our team at our office in Atlanta, GA. The Credentialing Specialist II will be responsible for credentialing and re-credentialing of behavioral health providers and facility organizations (hospitals, mental health centers, etc). The Credentialing Specialist II is responsible for collecting credentialing documentation and accurately building provider credentialing files according to contractual and NCQA standards using Beacon's NetworkConnect Credentialing System. The Credentialing Specialist I position requires independent business decisions to be made to complete credentialing files prior to submission to the Credentialing Committee. The Credentialing Specialist II is responsible for functions including but not limited to initial review of practitioner and facility applications, management of re-credentialing files, and obtaining primary source verification for completion of credentialing and re-credentialing files. The Credentialing Specialist II also acts as a resource to department team members and external departments in the day-to-day functions of the Credentialing Department.

Position Responsibilities:

  • Credential and re-credential behavioral health providers and facility organizations (hospitals, mental health centers, etc.) using Beacon's NetworkConnect credentialing system.
  • Perform verbal, written and on-line primary source verification for individual and facility organizations including but not limited to, state licensure, prescribing certificates/registrations, education, training and certification verification, accreditation status and exclusion data-base checks.
  • Accurately and timely perform data entry of all primary source verifications and select provider demographic and practice location information into Beacon's NetworkConnect credentialing system.
  • Stay current with knowledge of NCQA credentialing standards.
  • Credential and prepare credentialing and re-credentialing files for weekly Medical Director submission and bi-weekly National Credentialing Committee submission.
  • Monitor work queue to ensure applications are processed within expected turnaround times.
  • Meet or exceed production and quality standards.
  • Guide, support and advice junior members of the team.
  • Display a positive, constructive, and helpful demeanor to assist team members and offer suggestions that improve processes, culture or working environment.
  • Other duties as assigned.

    Position Requirements:

    Education: High School or High School equivalent. BA highly preferred

    Licensure: None

    Relevant Work Experience:
  • 2.5 years' experience in insurance, medical, healthcare or related field required, including six months' credentialing experience.
  • Six months' experience as a Beacon Credentialing Specialist I, meeting the production and quality standards of a Credentialing Specialist II for at least four months.
  • rofessional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn Beacon's internal systems.
    Ability to learn quickly.
  • Detail-oriented, analytical, highly organized and possessing problem-solving skills.
  • Ability to manage varying job pressures, and meet deadlines and handle multiple tasks simultaneously with minimal supervision.
  • Ability to work in a production environment and meet production and quality goals.
  • Computer literacy and experience with Microsoft office programs (Outlook, Word and Excel), Adobe PDF creator and internet searches. Experience working with fax machines, copiers and other office machines.


Knowledge, Skills & Abilities

:

  • Excellent written and verbal communication skills
  • Great analytical skills
  • Computer savvy

TO APPLY

Click below on "Apply for this Position" to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

$NFD

#CB

PM16

#GD

AAP Reporting Location:

n/a

ID (Req #):

56817

FTE Status:

Full Time

Schedule:

M-F 8:30 - 5:00

Non-Exempt

EOE
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Contact Information
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