Credentialing Operations Specialist - Temporary

Apply online at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving Hawai`i’s low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors, and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii’s third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.

The Culture:

AlohaCare employees have a passion for helping Hawai`i’s most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

Position Summary:

The Credentialing Operations Specialist will be responsible for receiving credentialing applications from all healthcare professionals (physicians, facilities, nursing, allied health, etc.). This includes reviewing applications for completion, verification of state licensure, and collecting information contained in several databases. Maintain credentialing and re-credentialing activities to ensure conformance with established organizational policy and procedures, national accreditation standards, and contractual state and federal requirements. Verify and track the provider’s credentialing data and prepare records as instructed by management. Other clerical duties as assigned.

Primary Duties and Responsibilities:

• Provides support with all AlohaCare credentialing processes and activities to ensure QUEST integration and Advantage Plus (CMS SNP) network adequacy requirements are met which include Individual Providers/Practitioners; Facilities; Long Term Services and Support (LTSS) providers credentialing.
• Perform triage and validation of credentialing applications and documentation.
• Process fax received, pick-up mail, scan and enter data for Intake.
• Ability to work independently to support all aspects of credentialing processes.
• Verifies provider information to complete primary source verification as needed.
• Prepares, organizes, and maintains credentialing documents to assist with the credentialing process within specified timeframes.
• Enters and updates Credentialing system and files.
• Maintains and monitors credentialing databases for day-to-day operations to support all credentialing activities.
• Communicates, both verbally and in writing with providers, administrators, and staff members regarding credentialing activities.
• Assists the Provider Relations, Credentialing Team and Contracts staff with credentialing inquiries providing responses and resolution in a timely manner.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Requirements:

• High school diploma or equivalent.
• Minimum of 1 year of administrative and/or clerical experience.
• Minimum of 1 year of customer service experience.
• Must have the ability to read, analyze, and interpret business documents such as a Credentialing Application.
• Proficient use and experience with Adobe products and programs.

• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
• Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Professional telephonic etiquette skills.
• Ability to solve problems, analyze, think critically, and make good judgments.
• Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• Able to work independently with minimal supervision.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.

• Possesses excellent time management and organizational skills; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Data entry experience with a high degree of accuracy and attention to detail.

• Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint.
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.

Preferred Requirements:

• Provider and Facility Health Plan credentialing experience.

Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• In an office working environment.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.

Salary Range: $19.00 - $22.00 an hour

Temporary hire through December 31, 2026

AlohaCare is committed to providing equal employment opportunities to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

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