American Specialty Health Incorporated is seeking a Credentials Examiner I to join our Practitioner Contract Administration team. This position will expedite credentials verification of practitioners in the credentialing or recredentialing process according to department standards, accreditation standards, regulatory requirements, and health plan expectations.

Remote Worker Considerations

Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment.This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).

Responsibilities

• Responsible to obtain information to credential new applicants and recredential participating practitioners according to department standards.
• Obtain required documentation by mail, fax, or phone and update practitioner files.
• Communicate with practitioners by mail, fax, or phone to answer questions and obtain information in a timely manner.
• Respond to provider inquiries within 48 hours of receipt via phone and/or email communication.
• Communicate with management any barriers for further support.
• Must successfully close a combined minimum number of 200 Rehabilitative files and 150 Specialty Credentialing files as set by department manager and subject to change based on business need.
• Must successfully close a minimum number of 200 Re-Credentialing files as set by department manager and subject to change based on business need.
• Ensure terminations and resignation requests are sent by set timeline established by department manager and can be subject to change based on business need.
• Enter data and perform research functions in Promis/PCT/SharePoint/ASHCore to complete each portion of the credentialing process within predetermined timelines.
• Must complete regulatory trainings within the timeframe provided by department manager.
• Perform all duties necessary in handling the credentialing and recredentialing process within predetermined timelines and state regulatory standards.
• Quality Assurance measures should maintain accuracy rate of no less than 99%.
• Abide by departmental work from home expectations.
• Abide by Attendance & Punctuality policy and department expectation.

Qualifications

• High School diploma required.
• Typing speed must be between 45-50 wpm.
• Proficient in MS Office, including experience with 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.

Mobility

Primarily sedentary, able to sit for long periods of time.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions

Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

#LI-Remote #Healthcare #Insurance #Credentialing #Credential #Administration