Lead, Credential Examiner

Administrative San Diego, California


Description

American Specialty Health, Inc. is seeking a Lead, Credentials Examiner to work with our Practitioner Contract Administration Department. This position will expedite credentials verification of practitioners in the credentialing or recredentialing process according to department standards, accreditation standards, regulatory requirements, and health plan expectations.  

You are invited to learn more about American Specialty Health’s events on our events page.  

Responsibilities

·        Responsible to obtain information to credential new applicants and recredential participating practitioners according to department standards.

·        Communicate complex issues with providers by mail, fax or phone to answer questions and obtain information to update provider files.

·        Complete admin review within 48 hours from the time the credentialing examiner closes the file.

·        Minimum of complete admin review of 35 files per day.

·        Enter data and perform research functions in Promis/PCT/SharePoint to complete each portion of the credentialing process within predetermined timelines. 

·        Support credentialing team by answering questions and assisting with the resolution of issues.

·        Handle complex credentialing issues and priority files as determined by management.

·        Train new credentials examiners.

·        Monitor the credentialing process and time frames to ensure performance standards are met.

·        Track staff production and errors and prepare reports for supervisor.

·        Work closely with staff to identify challenges in meeting performance and production standards.

·        Educate credentials examiners regarding new policies and procedures.

·        Responsible to complete credentialing or recredentialing files that require special attention and expertise.

·        Research credentialing issues by interfacing with supervisor, manager or other departments.

·        Assist with file assignment and other administrative tasks as needed.

·        Support supervisor and staff as necessary.

·        Prepare and distribute team meeting minutes.

Qualifications

·        High School diploma required.

·        Typing speed must be between 45-50 wpm.

·        A minimum of 1 year of Credentials Examiner experience.

·        Experience in all specialties both in credentialing and recredentialing.

Core Competencies

·        Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.

·        Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.

·        Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

·        Ability to effectively organize, prioritize, multi-task and manage time.

·        Demonstrated accuracy and productivity in a changing environment with constant interruptions.

·        Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.

·        Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.  

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.  

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.   

Please view Equal Employment Opportunity Posters provided by OFCCP here.  

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.  

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.