Credentialing Specialist

Job Description

Job Description

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

This is a Culinary Health Fund position

The Credentialing Specialist is responsible for all aspects of provider credentialing including but not limited to processing initial and re-credentialing applications for network of approximately 6000 providers 1500 + contracts. They will develop and maintain excellent on-going relationships with the providers and vendors, keeping satisfaction and engagement high. The specialist will be able to independently perform the functions of the Physician and Ancillary facility credentialing policies and procedures.

ESSENTIAL JOB FUNCTIONS AND DUTIES

• Develop and maintain excellent on-going relationships with providers and vendors
• Responsible for all aspects of provider credentialing including but not limited to processing initial and re-credentialing applications for network of approximately 5000 providers
• Communicate with Fund’s Credentialing Verification Organization to coordinate timely processing of files including being a liaison between the CVO and network providers to obtain information needed to complete the credentialing process
• Create and maintain all provider credentialing information in Fund’s provider database
• Maintain all ancillary provider monitoring documents including GLPL, state licensing, accreditations, Medicare certification, and business licensing.
• Responsible for preparing and distributing meeting materials for Fund’s Credentialing Committee Meetings
• Attend Credentialing Committee Meetings, interact with committee physicians, record and type meeting minutes for Legal and Committee Chairman review and approval
• Prepare post-meeting correspondence to providers as needed and ensure that all requests for information from Credentialing Committee are completed and prepared to report on at next meeting or as requested.
• Responsible for updating Fund’s credentialing policies and procedures when necessary and confirm all NCQA standards are upheld or revised as needed.
• Performs the above listed position functions independently (or with limited supervision) and within time frame defined for the specific task by Fund management
• Organize, prioritize and work on a variety of assignments
• Exemplifies the Fund's values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement

ESSENTIAL QUALIFICATIONS

Salary range for this position : Hourly : $25.69 - $31.44. Actual base salary may vary based upon, but not limited to : relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs) : Monday~Friday, 7.5 hours per day (37.5 hours per week) as a remote 8-4pm position.

We reward great work with great benefits, including but not limited to : Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Life, Pension, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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