Advantage Tech is seeking a Credential Rep for our Lee's Summit client.
· 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
- Highly detail oriented
- Medical or Dental office – duties include filing insurance, licensing, re-credentialing
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