[Hiring] Credentialing Representative @PPLSI

Role Description

As a Credentialing Representative, your primary responsibility is to oversee and manage the credentialing process within CLC’s organization. You will be maintaining all provider files (attorney and mediators), contracted and non-contracted in accordance with company policy, and maintaining contact and responding to provider inquiries. Your attention to detail and adherence to regulatory guidelines will play a crucial role in maintaining compliance and upholding the organization's reputation.

Responsibilities

• Collect and review credential applications for completeness and accuracy.
• Ensure all required documents, such as education, training, licensure, and certifications, are obtained and verified.
• Maintain a thorough understanding of regulatory requirements, accrediting standards, and internal policies related to credentialing.
• Manage the initial and re-credentialing processes for all network providers.
• Keep track of deadlines and ensure timely completion of the credentialing process.
• Verify the credentials for the accuracy of information provided by network providers including education, training, certifications, and licenses, through primary sources.
• Conduct thorough background checks with local state bar agencies.
• Evaluate network healthcare provider credentials to ensure they meet the required standards and qualifications.
• Assess and address any discrepancies or issues that arise during the credentialing process.
• Document and maintain records of verification outcomes.
• Ensure compliance with applicable regulatory requirements and accrediting standards.
• Stay updated with changes in regulations and standards and make necessary adjustments to the credentialing process.
• Maintain accurate and up-to-date records of network providers in a credential database.
• Enter and update information related to credentials, licenses, certifications, and other relevant details.
• Generate reports on credentialing status, expirations, and upcoming re-credentialing activities.
• Collaborate with internal and external stakeholders to address and resolve any compliance issues.

Qualifications

• 3 years of experience in customer service, preferably in a sales environment.
• High School diploma or equivalent required.
• Strong computer knowledge; proficiency in Microsoft Office applications.
• Types a minimum of 35 WPM.
• Compassionate, courteous, and concise communication skills.
• Excellent writing skills.
• Ability to educate customers effectively and accurately on products and services.
• Excellent telephone etiquette.
• Detail-oriented and strong organizational skills.
• Ability to multi-task with multiple assigned contracts.
• Accurately able to retain and document copious amounts of information.

Requirements

• Maintain excellent attendance and adherence.
• Able to retain copious amounts of information as it relates to the customer’s issue, the customer's benefits, and limitations.
• Prolonged periods of sitting or standing at a desk and working on a computer.
• Must be able to regularly lift and carry and otherwise move up to 15 pounds at times and occasionally up to 30 pounds.
• The ability to frequently physically move between departments/floors.
• Regularly required to use hands and fingers to handle, feel, or operate objects, tools, or controls, and reach with hands and arms.

Benefits

• Comprehensive benefits package including medical, dental, and vision coverage.
• Company-paid short-term disability and basic life and AD&D insurance.
• 401(k) retirement plan with company match.
• Paid time off, paid holidays, paid sick leave, and paid parental leave.
• LegalShield and IDShield membership plans.
• Eligibility for an annual or quarterly bonus based on company and individual performance.

Company Description

LegalShield is committed to equal employment opportunities and encourages women, minorities, individuals with disabilities, and veterans to apply. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, status as a protected veteran, and basis of disability or any other federal, state or local protected class.