Credentialing Specialist

NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members.

Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.

Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members.

We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.

Role:

Work collaboratively with the Provider Team, Call Center Specialists and other Nations Hearing employees. The person in this role will actively engage in day-to-day communications with Providers. This role requires excellent interpersonal skills to communicate effectively. They must be positive, energetic individuals with strong organizational skills, attention to detail and ability to multi-task. Basic to intermediate knowledge of Excel is required.

Key Responsibilities:

Communicate frequently and effectively on both inbound and outbound calls to Providers. This includes fielding Provider questions, concerns or complaints related to the credentialing process.

Effectively manage follow up calls and email.

Maintain records for individual rendering Providers who have been credentialed and\or have applied for credentialing.

Process, record, and track Provider Credentialing documents and data in processing systems and shared spreadsheets.

Monitor faxes, files and other sources of incoming Provider data notifications to ensure that Provider credentialing data is processed in a timely manner.

Communicate with providers to obtain updated documents as needed during and after credentialing process.

Maintain both electronic and hard copies of credentialing files and ensure they go into the appropriate storage spaces.

Update provider records and review for completeness and accuracy.

Synthesize and report on data related to credentialing status and attainment.

Draft, send, track and update Provider credentialing approval letters.

Review Provider applications prior to Credentialing Committee meetings to check for possible issues in applications so that they can be easily discussed at the meetings.

Coordinate with Network Accuracy Specialist to reconcile gaps in information on providers between our system and the Credentialing Report.

Take minutes at monthly Credentialing Committee meetings and distribute them for record keeping and approval.

Create presentations as needed.

Serve as a liaison with credentialing companies.

Special Projects as needed

Member overflow duties, as requested

Other duties as may be assigned

Requirements:

Bachelor's degree in computer science, Information Technology, or a related field or equivalent experience.

Healthcare credentialing experience

3+ years of experience as a Data Engineer or Analytics Engineer or similar role.

Proficiency in SQL, Python, or other relevant programming languages.

Strong experience with data warehousing concepts and tools.

Experience with ETL tools and processes.

Familiarity with data visualization tools.

Excellent problem-solving skills and attention to detail.

Strong communication and teamwork abilities.

Knowledge of data security and compliance standards is a plus.

Creative mindset

Basic to intermediate knowledge of Microsoft Applications

Quick learner and self-motivated

Ability to work as a team member or independently

Calm under pressure

Strong problem-solving skills

Professional presentation and demeanor

Availability of working after normal business hours including weekends and holidays, when needed