American Health Partners

Job Details

Description

You must reside in one of the following states for this position:

AL, AR, AZ, GA, IA, ID, IL, IN, KS, KY, LA, MI, MO, MS, NY, OH, OK, PA, SC, TN, TX, UT, WI

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 access to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts with company match
• Employee Referral Bonus Program

JOB SUMMARY:

The Facility Credentialing Specialist ensures all contracted providers meet qualifications to provide care by working closely with multiple departments. This position is also responsible for assisting and supporting reporting functions of data to appropriate agencies, committees and management while meeting Health Plan standards.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

• Although this position can assist with provider credentialing, the main focus for this position will be Facility Credentialing.
• Must be able to review and verify credentials, i.e. licenses, certifications, etc., in a timely manner
• Make sure organizations are compliant with regulatory requirements.
• Maintain and load provider credentialing information received via contracts, roster updates and/or applications into the system
• Review data for accuracy, correct errors as needed
• Keep current on NCQA Standards and/or industry-specific regulations
• Contact providers in a timely manner to obtain missing and/or incorrect documentation: follow up as necessary
• Participate on calls with network services staff to assist with troubleshooting
• Assist with the facilitation of the Credentialing Committee approval and denial notification process (i.e. welcome and denial letters)
• Other duties as assigned

JOB REQUIREMENTS:

• Must be fluent in all provider types
• Must be able to accept instructions and work independently in the completions of goals and assignments
• Proficient computer skills
• Must be self-motivated, dependable, team and goal-oriented
• Ability to accurately enter data into information system as instructed
• Ability to prioritize and multi-task workload
• Be efficient, effective and assertive in both written and spoken communications
• Handle multiple priorities effectively

QUALIFICATIONS:

• Education:

o High school diploma or equivalent required

o Post-secondary education preferred

• Experience:

o Previous experience in the healthcare field required

o Prior credentialing experience required

o Prior experience in network services data management preferred

o Prior experience with Medicare Advantage plans preferred

SUPERVISORY RESPONSIBILITIES:

• Does not have supervisory responsibilities
• Occasionally needs manager’s direction due to extraordinary circumstances

WORKING CONDITIONS:

• Audio-Visual: Hearing: Good
• Prolonged periods of sitting at a desk and working on a computer
• Work is typically performed at home in a dedicated office space
• Typical working hours are 8:00 AM to 5:00 PM but flexible
• Position may require flexible hours
• Must be able to speak and write in English
• Travel may be required to come into corporate office for special events

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EEO

This employer participates in E-Verify.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.