Credentials Examiner

Credentials Examiner at American Specialty Health

American Specialty Health Incorporated (ASH) is seeking a Credentials Examiner to join our Credentialing department. This remote role is crucial for expediting credentials verification of practitioners in both the initial credentialing and recredentialing processes, ensuring compliance with department standards, accreditation requirements, regulatory guidelines, and health plan expectations.

Remote Work Expectations

This position requires you to work from home (WFH) in a designated work area, utilizing company-provided technology equipment. You must have a stable connection to your Internet Service Provider, capable of supporting video calls on a reliable network (minimum 50 Mbps download and 50 Mbps upload speed). All initial training will also be conducted remotely.

Key Responsibilities

• Obtain necessary information and documentation for credentialing new applicants and recredentialing participating practitioners.
• Communicate effectively with practitioners via mail, fax, or phone to answer inquiries and secure required information promptly.
• Respond to provider inquiries within 48 hours via phone and/or email.
• Escalate any barriers to management for support and resolution.
• Successfully close a combined minimum of 200 Rehabilitative files and 150 Specialty Credentialing files, as well as a minimum of 200 Re-Credentialing files, as per departmental standards (subject to change based on business needs).
• Ensure termination and resignation requests are processed within established timelines.
• Accurately enter data and perform research in Promis, PCT, SharePoint, and ASHCore to complete credentialing processes within predetermined timelines.
• Complete all mandatory regulatory trainings within specified timeframes.
• Perform all duties related to the credentialing and recredentialing process in adherence to predetermined timelines and state regulatory standards.
• Maintain a quality assurance accuracy rate of no less than 99%.
• Adhere to all departmental work-from-home expectations, as well as the company's Attendance & Punctuality policy.
• Perform other duties as assigned and comply with all company policies and standards.

Qualifications

• High School Diploma or GED certificate required.
• Typing speed must be between 45-50 words per minute (wpm).
• Proficient in Microsoft Office Suite, with demonstrated experience using Excel.

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.

Key skills/competency

• Credentialing
• Practitioner Verification
• Data Entry
• Regulatory Compliance
• Customer Service
• Communication Skills
• MS Office Proficiency
• Time Management
• Accuracy
• Confidentiality