Specialist, Credentialing Operations - Providence Rhode Island

Company: Evolent Health
Location: Providence, Rhode Island
Posted On: 05/18/2024

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You'll Be Doing:

The Specialist, Credentialing Operations will be a dynamic role that will encompass determining provider types who require credentialing, initiating the Primary Source Verification Process (PSV), performing provider outreach, and administrative auditing. This position reports to the Associate Director, Credentialing Operations.

Collaboration Opportunities:

The Specialist, Credentialing Operations team collaborates with the Provider Data Management (PDM) team through our Jira ticking system.

What You Will Be Doing:

Maintenance of provider data within the credentialing platform.

Ticket intake and triage for internal/externally submitted tickets.

Responsible for credentialing and re-credentialing files, including both Type I and Type II files.

Maintain working knowledge of and comply with NCQA credentialing and recredentialing guidelines.

Maintain working knowledge of and comply with partner specific credentialing and recredentialing guidelines, policies, and procedures.

Ongoing monthly monitoring of exclusions, sanctions, and adverse events.

Represent Credentialing department in meetings and delivering special projects and maintaining concurrent projects as assigned.

Establishing and maintaining excellent relationships, internally and externally including communication to the leadership team.

Maintain contractual service level and/or operational level agreements, as applicable.

Maintenance of credentialing and provider data management systems, including the Counsel of Affordable Quality Healthcare (CAQH), Credentialing Systems, SPayer, Symplr and proprietary claims system and Power BI Tool.

Qualifications - Required and Preferred:

Bachelor's Degree or equivalent years of work experience- Required.

Excellent verbal and written communication skills- Required.

Detail oriented with good organizational skills- Required.

Ability to work in an agile space and adapt to fluctuating situations- Required.

Takes initiative and works independently - Required.

Ability to time manage and reprioritize tasks/projects as appropriate Required.

Microsoft Office Suite, including Word, Excel, PowerPoint, Outlook- Required.

Counsel of Affordable Quality Healthcare (CAQH), Credentialing Systems, SPayer, Symplr and proprietary claims system and Power BI Tool -Preferred.

Minimum of two to three years' experience in healthcare field related to credentialing, provider enrollment, provider services, and/or configuration- Preferred.

General understanding of US health care, Managed Care Organizations, Medicare and/or Medicaid- Preferred.

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $25.00 up to $27.00 per hour. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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For more insights about Evolent Health, click on Life At Evolent (https://www.evolent.com/) to learn more! More...

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