Credentialing Intake Specialist
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
The Credentialing Intake Specialist independently analyzes credentialing applications for completeness and accuracy to determine if credentialing criteria is met and is compliant with corporate, state, federal and accreditation requirements and guidelines.
· Completes primary source verifications of practitioner credentials as required by corporate, state, federal and accreditation standards.
· Utilizes approved verification sources.
· Supports decisions and verifications with appropriate documentation and rationale in the practitioner’s electronic record.
· Manages their daily workflow by running daily reports from the credentialing database to meet accreditation and/or corporate requirements and timeframes.
· Performs other assigned duties as needed per credentialing department needs.
· Documents all outreach/contacts/verifications correctly into the practitioner’s record in the credentialing database.
· Scans and attaches all supplemental documentation received during the credentialing process to the electronic practitioner record
· Assures that all verifications, signatures and documentation used in the credentialing process is current and effective to meet the NCQA MCO and CVO requirements.
· Affirms the confidentiality and integrity of all aspects of the verification process.
Qualifications:
· Bachelor's degree in related field or equivalent experience with a minimum of two years credentialing, quality assurance, or auditing experience.
· Excellent research, analytical ability and decision-making skills are required.
· Demonstrated organizational ability with attention to detail.
· Excellent communication skills both verbal and written. Composes professional, quality correspondence – letters, emails or memos -- with an emphasis on grammatical accuracy and content clarity.
· Demonstrated phone skills. Proficiency in using a computer.
· Prior experience in working with database applications preferred.
· Demonstrated ability to make good decisions based on common sense.
· Prior CPR or provider database experience preferred.
· Proficiency in accessing/researching external websites.
Hybrid
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Diversity, Equity, and Inclusion
At Independence, 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.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.