at Highmark Health in Springfield, Illinois, United States
Job Description :
This job develops, implements and manages the credentialing/re-credentialing program for network practitioners and providers. Develops, implements and manages the delegated credentialing program. Manages the day-to-day operations of the credentialing program.
+ Develop and implement policies and procedures for the establishment of processes, which will ensure timely and accurate credentialing and re-credentialing of network practitioners and providers.
+ Review policies and procedures for continued applicability.
+ Collaborate closely with staff of various departments to identify and document issues and performance.
+ Meet the standards of external monitoring agencies.
+ Meet with appropriate committees to review new applications and re-credentialing applications.
+ Ensure the company is in compliance with its oversight and due diligence requirements for entities to which it delegates credentialing.
+ Other duties as assigned or requested.
+ High School Diploma / GED
+ 5 years of credentialing experience
+ 1 year of experience in management
+ Bachelor’s degree
+ 3 years of experience in managed care
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Is Travel Required?
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
Pay Range Maximum:
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated\files/employers/poster\screen\reader\optimized.pdf )
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J227576