PacificSource Health Plans

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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Assist in the credentialing/re-credentialing process for practitioners and facilities for network participation. Ensure all credentialing/ re-credentialing certification processes and procedures are completed in accordance with established regulatory and policy requirements. Coordinate and review all credentialing/ re-credentialing applications from new and existing providers; complete follow-up and problem resolutions as requir3ed. Interpret material received for timeliness and contact individual practitioners or department representatives for necessary information. Coordinate the processing, distribution, and management of all credentialing documents for practitioners insuring the information is verified.

Essential Responsibilities:

• Manage receipt of all credentialing/ re-credentialing applications and enter data into the credentialing database.
• Manage monthly re-credential mailings and follow-up with practitioners when there is no response.
• Facilitate and assist with internal and external record audits as appropriate.
• Assist in maintaining a comprehensive database to prepare reports and summaries as appropriate.
• Complete other department administrative tasks including: create meeting agendas and prepare minutes; order supplies, assist with provider workshops, and assist with department mailings.
• Update provider appointment status from monthly term reports supplied by Operations and run the weekly credentialing report, validate entries and share with Provider Relations/Contracting.

Supporting Responsibilities:

• Assist as backup to the operations department daily support staff during vacation and illness absences.
• Assist in delegation data management
• Download of electronic credentialing applications from outside entities
• Assist in data integrity audits
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information..
• Perform other duties as assigned.

Work Experience: One year experience working in a position that requires attention to details, multi-tasking and contributing to a positive work environment required or 6 months internal PacificSource experience.

Education, Certificates, Licenses: High school diploma or equivalent required.

Knowledge: A general understanding of credentialing. Proficiency in Word, Excel, Adobe Pro and Access with emphasis on database management. Ability to make administrative and procedural decisions and judgments. Ability to develop and maintain record keeping systems and procedures including maintaining of filing systems. Must be detail oriented with excellent customer service skills. Effective written and verbal communications skills and professional telephone skills. Exceptional grammar, spelling, punctuation, consistency, and editing skills. Excellent interpersonal skills.

Competencies:

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.