Credentials Examiner I

About the Credentials Examiner I Role at American Specialty Health Incorporated

American Specialty Health Incorporated (ASH) is actively seeking a Credentials Examiner I to join its dedicated Credentialing department. This pivotal remote role focuses on swiftly verifying practitioners' credentials during both initial credentialing and recredentialing cycles.

As a Credentials Examiner I, you will ensure all processes adhere strictly to departmental benchmarks, rigorous accreditation standards, regulatory mandates, and health plan expectations, playing a crucial part in maintaining the integrity and compliance of ASH's practitioner network.

Remote Work Environment

This is a fully remote position, requiring a designated home workspace equipped with company-provided technology. Successful candidates must maintain a stable internet connection, capable of reliably supporting video conferencing (minimum 50 Mbps download and 50 Mbps upload speeds are required).

Key Responsibilities

• Obtain necessary information for credentialing new applicants and recredentialing existing practitioners, adhering to department standards.
• Gather required documentation via mail, fax, or phone, and accurately update practitioner files.
• Communicate effectively with practitioners via mail, fax, or phone to address inquiries and collect timely information.
• Respond to provider inquiries within 48 hours through phone and/or email.
• Escalate any encountered barriers to management for support.
• Successfully close a combined minimum of 200 Rehabilitative and 150 Specialty Credentialing files, subject to departmental adjustments.
• Achieve a minimum closure of 200 Re-Credentialing files, as defined by department management.
• Ensure timely submission of termination and resignation requests according to established departmental timelines.
• Perform data entry and research functions using Promis, PCT, SharePoint, and ASHCore to complete credentialing processes within set timelines.
• Complete all mandatory regulatory trainings within specified deadlines.
• Manage the entire credentialing and recredentialing process in compliance with predetermined timelines and state regulatory standards.
• Maintain a quality assurance accuracy rate of no less than 99%.
• Adhere strictly to departmental work-from-home guidelines and the Attendance & Punctuality policy.
• Undertake additional duties as assigned and comply with all company policies and standards.

Required Qualifications

• High School Diploma or GED certificate is mandatory.
• Typing speed must be between 45-50 words per minute.
• Proficiency in MS Office, specifically with Excel, is essential.

Core Competencies

• Proven ability to interact positively and respectfully, fostering cooperative working relationships.
• Exceptional customer service skills to meet the needs of both internal and external stakeholders.
• Strong listening and interpersonal communication skills to identify critical success factors.
• Excellent organizational, prioritization, multitasking, and time management abilities.
• Demonstrated accuracy and productivity even in dynamic environments with interruptions.
• Capability to analyze information, problems, and procedures to develop effective solutions.
• Commitment to exercising strict confidentiality in all sensitive matters.

Physical and Environmental Requirements

This role is primarily sedentary, requiring the ability to sit for extended periods. Candidates must be able to see, speak, and hear, communicate verbally and in writing, and navigate a work-from-home environment. Proficiency in using a telephone, computer keyboard, and mouse is required, with the ability to lift up to 10 lbs. The work environment is exclusively remote.

Key skills/competency

• Credentialing verification
• Regulatory compliance
• Accreditation standards
• Data entry
• Microsoft Office
• Customer service
• Time management
• Communication skills
• Confidentiality
• Research