Credentials Examiner I

Administrative San Diego, California


Description

American Specialty Health is seeking an Credentials Examiner to credential or recredential practitioners, 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

  • Obtain required documentation by mail, fax, or phone and update practitioner files.
  • Communicate with practitioners by mail, fax, or phone to answer questions and obtain information.
  • Must successfully close a minimum number of files as set by department manager and subject to change based on business need.
  • Enter data and perform research functions in Promis/PCT/SharePoint to complete each portion of the credentialing process within predetermined timelines. 
  • Perform all duties necessary in handling the credentialing and recredentialing process within predetermined timelines.
  • Maintain accuracy rate of no less than 99%.

Qualifications

  • High School diploma required.
  • Typing speed must be between 45-50 wpm.

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 oral 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.