Credentialing Specialist III (Spokane, WA or Remote Opportunity)

Guardian Life Insurance Company - Spokane, WA3.7

30+ days agoFull-time
Credentialing Specialist III (Spokane, WA or Remote Opportunity) - (18000723)
Description

Position Overview
The Credentialing Specialist III is a junior member of the credentialing department’s leadership team. They primary responsibilities of this position include the auditing of credentialing and re-credentialing files, performing the pre-delegated and annual oversight audits for those provider groups with delegated credentialing, assists in the training needs of department staff, drafts departmental policies and operating procedures and supports any third-party audits requiring credentialing information.

Essential Job Functions and Responsibilities:
Responsible for conducting pre-delegation and annual file audits for all delegated provider entities according to NCQA guidelines and prepares report of findings for review by Credentialing Committee
Performs final step in credentialing/re-credentialing process to ensure accuracy and completeness of provider file before presenting to Credentialing Committee
Identifies provider file as “clean” or “needs review” according to departmental policies and prepares documentation for Credentialing Committee
Assists management in preparing for health plan and SOC1 audits
Works with management to draft desktop procedures as needed
Reviews existing departmental policies and procedures annually and works with management to make updates as needed
Assists management with training needs within the department
Performs special project work as assigned
All other duties as requested
Reporting Relationships
This position reports into the Manager of Credentialing

Qualifications

Qualification Requirements:
Minimum 3-5 years relevant credentialing experience in a managed care setting
Expert knowledge of NCQA guidelines
Proficiency in computer and software programs (e.g., MS Word, Excel, Share point)
Ability and desire to embrace change, while maintaining a high level of productivity
A commitment to excellence, strong interpersonal, oral and written communication skills required
Critical thinking, detail oriented and strong organizational skills required
Excellent interpersonal, oral and written communication skills required
Critical thinking, detail oriented and strong organizational skills required

Leadership Behaviors
Actively coaches and develops team members to meet department productivity and quality standards
Fosters a culture where diverse thoughts, experiences and backgrounds are valued
Continuously strives to provide superior products and customer service
Demonstrates self-awareness and embraces feedback

Preferences:
Bachelor’s degree preferred
CPCS certified preferred
Experience working with Cactus system desired
Experience with delegated credentialing audits highly desirable
Knowledge of dental industry desired

Travel:
10% Travel - travel to perform delegated audits onsite or travel to Guardian locations may be required, as needed.

The Guardian Life Insurance Company of America® (Guardian), currently ranked #218 on the Fortune 500, is one of the largest mutual life insurers.

As of December 31, 2017, Guardian reports $1.6 billion in operating income, $8 billion in capital, and $71.5 billion in assets under management. Guardian consistently scores high marks for financial strength from all four major credit rating agencies and enjoys a strong competitive position in its major businesses: life insurance, disability income insurance, annuities, investments, dental and vision insurance and employee benefits.

As a mutual company founded over 157 years ago, Guardian is owned by its policyholders. The company has paid dividends to policyholders every year since 1868 and the Company’s 8,800 employees and 2,750 financial representatives are aligned with its mission to help individuals, families, and small businesses achieve financial security and protection.

Guardian states its aspiration in the following way: “To be the trusted mutual partner, delivering financial security how, when, and where our clients prefer.”

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.
Guardian2018

Primary Location: United States-Washington-Spokane
Job: Administrative/Clerical/Billing
Schedule: Full-time
Shift: Day Job
Job Type: Standard
Travel: Yes, 10 % of the Time
Job Posting: Jun 29, 2018, 3:07:50 PM