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Credentialing Representative (Hooksett, NH)
Ref No.: 19-07933
Location: Hooksett, New Hampshire
Duties:
  • This position is responsible for working within implemented procedures related to credentialing and re-credentialing of medical and behavioral facilities.
  • Must be able to accurately and efficiently process initial credentialing and re-credentialing application as well as follow specific guidelines listed in CR-04 and job aids.
  • Reviews and process initial credentialing and re-credentialing application for Medical and Behavioral Line of Business.
  • Manage/Oversees centralized verification of current licensure and certification for Medical and Behavioral facilities and Ancillaries.
  • Conduct thorough review of obtained credentialing information to ensure compliance with policy and regulatory requirements.
  • Establish and maintain constant communication with Contracting or other matrix partners to ensure facilities updated information have been acquired and make necessary adjustments as needed.
  • Serve as a Subject Matter Expert and act as a resource for management and matrix partners.
  • Obtain Primary Source Verification via secure website.
  • Ensure timely follow-up and processing to meet agreed upon standards.
  • Consistently achieves 100 % accuracy on all systems data entry.
  • Manages assigned mailboxes and responds to inquiry accurately and within the department standards.
  • Run credentialing committee and bariatric reports timely and accurately.
  • Complete projects as assigned.
Skills:
  • Ability to work constructively in a team environment
  • Strong organization and time management skills; effectively adapts to multiple and/or competing priorities
  • Excellent communication, collaboration and interpersonal skills in order to work effectively with matrix partners
  • Aptitude for detail and ability to follow procedural standards
  • Strong analytical and problem solving skills
  • Proficient in MS office, Excel, Outlook and Word
  • Flexible with change and able to make decisions
  • Demonstrate a CAN DO attitude
Education:
  • High School Diploma/GED
Languages:
  • English Read Write Speak