Data Management Lead

Advantage Tech is seeking a Credential Rep for our Lee's Summit client.  

 JOB DESCRIPITON:

·         Administers the credentialing process via vendor network. Works independently to coordinate, develop, monitor and maintain the credentialing process under the supervision of the Supervisor, Credentialing.

 

Duties and Responsibilities

  • Performs reviews of provider applications. Determines eligibility by applying GEHA’s credentialing criteria and submits completed files to the Peer Review Committee and supervisor for approval and participation in the network.
  • Attends Peer Review Committee and provides reports regarding provider application information.
  • Analyzes and resolves provider file issues, tracks progress on vendor network management, and produces reports.
  • Reviews and analyzes provider file changes.
  • Responds to provider inquiries received by letter, phone, or from internal departments.
  • Administers re-credentialing of network providers.
  • Reviews and monitors provider complaint and grievance files.
  • Assists supervisor with denied provider and quality assurance processes.
  • Assists other team members as needed to maintain departmental TAT.

Knowledge, Skills, and Abilities

  • Requires two years (60 hours) of college
  • Requires two years of experience in managed care or health insurance administration, business administration, sales/marketing, or account management
  • Additional years of analytic experience may be considered in lieu of education
  • Requires effective verbal and written communication skills to communicate with providers and GEHA management staff

PREFERRED:

  • Salesforce
  • Highly detail oriented
  • Medical or Dental office – duties include filing insurance, licensing, re-credentialing

Advantage Tech is proud to be recognized as Kansas City Business Journal’s #1 locally owned IT staffing firm. We are passionate about delivering world-class service and value to our consultants and clients. 

Please visit www.advantagetech.net to learn more about our culture, benefits and career opportunities.

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