Associate Credentialing Representative

Company : Highmark Inc.

Job Description

JOB SUMMARY This job processes provider applications and re-applications including initial mailing, review, and loading. Maintains provider data base and communicates with providers by phone and mail regarding credentialing status and information.

Performs credentialing, re-credentialing and related activities and coordinates credentialing verifications. Reviews and processes more complex additions, updates and deletions of provider information in the Dental Provider file database.

Supports the implementation of new networks, systems, software, guidelines and other endeavors with a focus on “group practices” as opposed to individual providers. Depending on level, trains credentialing personnel in the use of various systems, software, databases and procedures.

Participates in projects which streamline, automate or otherwise enhance credentialing functions. ESSENTIAL RESPONSIBILITIES Credential and re-credential providers. Contact providers or representatives by telephone or in writing to obtain additional information while processing their enrollment applications.

Screen incoming applications and paperwork for completeness and accuracy and sends necessary paperwork to credentialing vendor. When necessary performs credentialing verifications and loads provider to appropriate networks and credentialing information to the provider database.

Manage credentialing inventory, reports and projects to ensure all established time frames for completing work, reports and projects are met. Depending on level, train credentialing team in the use of various systems, software, databases, processes and procedures.

Create and distribute monthly reports as assigned and handle complex and unusual or high-level credentialing issues. Support projects, audits, business partners, internal departments and external clients. Represent department as the Subject Matter expert.

Pull and research necessary documentation for audits Support updates necessita