Responsibilities
Performs activities related to credentialing and re-credentialing of network providers, while ensuring adherence to the Health Plan, regulatory, industry and delegation standards. Conducts credentialing audits; oversees maintenance of documentation, provider files and related databases. Works under general supervision. Education: Associate's degree in business, healthcare administration or a related field, or the equivalent required. Bachelor's degree in business, healthcare administration or a related field, or the equivalent preferred. Experience: Minimum of two years managed care or hospital experience, preferably in the area of credentialing or provider relations required. Proven track record of credentialing and re-credentialing processes with an emphasis on compliance to NCQA, Medicare and Medicaid regulatory standards and requirements. Excellent organizational and PC skills required. Strong written and verbal communication skills, and ability to work independently in a team environment required.