What are the responsibilities and job description for the Credentialing Specialist position at AmeriHealth Caritas Health Plan?
Your career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Responsibilities:
The Credentialing Coordinator is responsible for processing and completing the credentialing and re-credentialing functions of all providers in accordance with NCQA, state, and federal requirements.
Principal Accountabilities:
- Validates completeness of provider applications prior to processing.
- Conducts primary source verification for all credentialing and re-credentialing applications.
- Monitors the progress and completion of all site visits by the provider network team to ensure completion within the established timeframe.
- Accurately enters all critical data elements of provider applications into the Credentialing system.
- Responds to phone inquiries received in the Credentialing phone queue from internal and external clients.
- Completes projects as assigned.
Education/ Experience:
- High School/GED with 4 years of experience OR
- Associate’s Degree with 1 to 2 years of experience OR
- Bachelor’s Degree with 0 to 1 years of experience.
- 0 to 4 years of prior provider credentialing experience based on a combination of education and experience.
Other Skills:
- Intermediate knowledge of PC applications, including Microsoft Office.
- Strong verbal and written communication skills.
- Strong organizational skills required.
- Ability to perform in a metrics-driven environment.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
