Credentialing Specialist

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

This position is responsible for meeting the requirements for credentialing as defined in CareOregon policies and procedures. Works closely with the Credentialing Supervisor in the credentialing process.

Essential Responsibilities

• Review provider credentialing applications and verify information for completeness and accuracy.
• Enter provider information in databases, maintaining accuracy and completeness of provider information.
• Communicate with providers regarding application process and content by telephone and in writing.
• Communicate confidential and sensitive information with provider offices and regulatory agencies.
• Maintain systems for managing the credentialing process including paper and electronic files.
• Verify healthcare professional’s information with external verification sources, such as Oregon Board of Medical Examiners and National Practitioner Data Bank and other sources as indicated.
• Produce materials and information for the Senior Medical Director, Credentialing Supervisor, Credentialing Committee and CareOregon Board.
• Attend and participate in Credentialing Committee meetings as directed by Credentialing Supervisor.
• Prepare routine correspondence in accurate and timely manner.
• Maintain a detailed and confidential credentialing system.
• Participate in delegation oversight process, including data entry and audit process, as directed by the Credentialing Supervisor.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 1 year experience in health plan credentialing or medical staff office
• Minimum 1 year experience with high-production word processing
• Minimum 1 year experience in using Access or other databases

Preferred

• CPCS or equivalent

Knowledge, Skills and Abilities Required

Knowledge

• Knowledge of current credentialing regulations and requirements; NCQA, Medicare and Medicaid
• Knowledge of provider credentialing processes
• Knowledge of filing systems
• Knowledge of the basic concepts of Managed Care

Skills and Abilities

• Ability to retain and maintain confidential files
• Competency with word processing
• Competency with spreadsheet and database programs
• Excellent customer service skills
• Excellent written and verbal communication skills
• Ability to manage multiple tasks
• Ability to work in a confidential manner with Provider information
• Ability to work as a member of a team in a collaborative manner
• Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with coworkers and others

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

#Li-Hybrid

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.