Associate Specialist Corporate Credentialing

@ Molina Healthcare

Job Summary

Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and maximize safety for members. The Associate Specialist Corporate Credentialing is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions for practitioners and health delivery organizations according to Molina policies and procedures. The role also involves meeting daily/weekly production goals and maintaining confidentiality for provider information.

Job Duties

• Evaluate credentialing applications for accuracy and completeness.
• Obtain required verifications per Molina policies and regulatory needs.
• Communicate with providers to clarify questions and request missing information.
• Update credentialing software systems with necessary information.
• Request and follow-up on recredentialing applications.
• Collaborate with internal and external contacts to ensure timely processing.
• Maintain and correct data in the credentialing database.
• Review claims payment systems and provider statuses as needed.
• Process daily alerts for sanctions, exclusions, and Medicare Opt-Out reports.
• Handle NPDB Continuous Query reports with appropriate actions.

Job Qualifications

Required Education: High School Diploma or GED.

Required Experience: Experience in a production or administrative role, strong critical thinking, extensive computer use (internet research, Microsoft Outlook, Word, and other software systems), and professional written and verbal communication skills.

Preferred Experience: Experience in the healthcare industry.

Key skills/competency

• credentialing
• recredentialing
• compliance
• production
• confidentiality
• healthcare
• risk management
• regulatory
• communication
• data processing