Credentialing Coordinator I

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Assists with all functions related to the credentialing and recredentialing process for clinicians as designated by the Massachusetts Board of Registration in Medicine, NCQA, MassHealth, and Plan policies and procedures.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Initiates the collection of all pertinent information/documentation from Providers and their office staff. Verifies credentials through the appropriate primary sources.
• Independently reviews credentialing files to ensure completion and accuracy of information, per Plan's policies. Ensures all files are completed in a timely manner, and meet the appropriate turnaround requirements.
• Reviews sanction and exclusion sources to ensure that providers going through initial credentialing or recredentialing process are not currently debarred, suspended or otherwise excluded from participation in Medicare, Medicaid or any other federal or state health care programs.
• Responsible for managing internal provider data queues (e.g. Terminations, Non-Pars).
• Organizes and maintains assigned electronic credentialing files. Responsible for updating provider information within the appropriate databases.
• Maintain detailed log of all pending work.
• Supports special projects and completes other duties, as assigned.

Supervision Received:

• Close supervision is received daily.

Qualifications:

Education:

Preferred/Desirable:

• High school diploma or GED required.
• Bachelor's degree in healthcare administration, related field, or equivalent combination of education, training and experience is preferred.

Experience:

• 2 or more years of credentialing experience in a health plan or a hospital medical staff services department.

Certification or Conditions of Employment:

• Pre-employment background check

Competencies, Skills, and Attributes:

• Strong oral and written communication skills;
• Ability to interact with other departments within the organization, and with external audiences
• Maintains a basic understanding of the National Committee for Quality Assurance (NCQA) accreditation standards, MassHealth, NH DHHS and other Federal/State credentialing requirements
• Strong analytical skills
• Accurate and detail oriented
• Flexible and able to work with minimal supervision
• Ability to manage multiple tasks and possess excellent organizational and time management skills
• A basic working knowledge of Microsoft Office products

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Ability to work overtime during peak periods.
• Work is normally performed in a typical interior/office work environment.
• Very limited or no physical effort required. Very limited or no exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees