Managed Care Credentialing Specialist

JOB SUMMARY

Acts as the liaison between our Agencies / Facilities and our managed care plan partners. Participates in strategic decisions and efforts as they pertain to new contracting opportunities, maintains tools and processes to support the completion of timely, compliant, and accurate managed care credentialing applications. A qualified candidate will have a minimum of three years of experience in credentialing. The Managed Care Credentialing Resource will play a vital role in ensuring that our organization maintains compliance with all credentialing requirements set forth by managed care organizations. This individual will be responsible for managing the credentialing process for Pennant Home Health, Hospice, Personal Care Agencies, and Senior Living Facilities within our organization, ensuring that they meet the necessary qualifications and standards to participate in various managed care networks. The ideal candidate will have a strong understanding of credentialing procedures, excellent organizational skills, and the ability to collaborate effectively with internal and external stakeholders.

DUTIES & RESPONSIBILITIES

This full-time position reports to the Director of Managed Care and is responsible for all aspects of credentialing and re-credentialing for those geographic regions assigned across the organization.

• Works independently to ensure full compliance with all applicable policies, procedures, bylaws, rules, and regulations, accreditation standards, and regulations for the processing of applications for initial credentialing and re-credentialing.
• Communicate with managed care organizations to obtain and verify credentialing requirements, submission guidelines, and status updates.
• Ensure that all credentialing applications are completed accurately and submitted in a timely manner to meet managed care organization deadlines.
• Coordinates with our Legal, Licensing, Accounts Receivable, and Payor Admin to verify and obtain pertinent information.
• Maintain a comprehensive database of Agency / Community credentialing documents.
• Expected to represent our Agencies / Communities and company professionally to all managed care plans and external partners.
• Assist Managed Care Resources and team with special contracting projects as assigned.
• Manage the assigned credentialing email inbox.
• Serve as a liaison between our Agencies / Communities and managed care organizations regarding credentialing matters, responding to inquiries, and providing necessary information as needed.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)

Desired Qualifications :

Additional Information

We are committed to providing a competitive Total Rewards Package that meets our employees' needs. From a choice of medical, dental, and vision plans to retirement savings opportunities through a 401(k) plan with company match and various other benefits, we offer a comprehensive benefits package. We believe in great work, and we celebrate our employees' efforts and accomplishments both locally and companywide, recognizing people daily through our Moments of Truth Program. In addition to recognition, we believe in supporting our employees' professional growth and development. We provide employees a wide range of free e-courses through our Learning Management System as well as training sessions and seminars.

Compensation : Based on experience.

Type : Full Time

Location : Pennant Service Center Nashville, TN

Why Join Us

At Pennant Services, we don't just manage-we lead like owners . Our unique culture is built around empowerment, accountability, and growth. We invest in people who are ready to build and own their impact.

What sets us apart :

Customer Second

Accountability

Passion for Learning

Love One Another

Intelligent Risk Taking

Celebrate

Ownership

About Pennant

Pennant Services supports over 180 home health, hospice, senior living, and home care agencies across 14 states. Our Service Center model enables local leaders to lead, while we provide centralized support for clinical, HR, IT, legal, and compliance needs, empowering them to succeed.

Learn more at : www.pennantgroup.com

#Hybrid

Pennant Service Center

1675 E. Riverside Drive, Suite 150

Eagle, ID 83616

The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at