Credentialing Research Specialist

Columbia MD 21046 8621 Robert Fulton Drive

Job Description

In response to requests from Credentialing Operations, performs research of state specific licensure and credentialing requirements. Reviews, researches, and reaches out to practitioners, when the credentialing process identifies adverse licensure or malpractice information. Maintains/updates resources and tools in response to research findings, and manages all queues within timeliness expectations. Excellent provider and internal customer service skills are essential to the successful performance of this role
  • Performs daily management of criteria/legal process.
  • Researches credentialing applications for initial and re-credentialing that containing adverse information.
  • Applies policies and established guidelines to determine appropriate next steps.
  • As needed, manages confidential outreach for sensitive documentation pertaining to those applications (lawsuits, board actions).
  • Monitors and completes annual tracking of PSV of education and training evidence to be gathered from approximately 800 state license boards.
  • Ensures timeliness of evidence, and identification/retention of accurate data.
  • Performs detailed state-specific research in response to submitted requests from internal customers.
  • Ensures credentialing guidelines/resources are updated in response to regulation changes.
  • Develops an understanding of the Credentialing Process and how these tasks and this role support the department and company.
  • Maintains internal resource tools (Credentialing Criteria Database, etc.).
  • Ensures all assigned duties are completed within expected timeframes.

General Job Information

Title

Credentialing Research Specialist

Grade

18

Job Family

Operations Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

11/2/2018

Date Requisition Created

11/2/2018

Minimum Qualifications

Education

Bachelors, GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 2+ years of credentialing, research, and/or customer service experience.
  • Comfortable with internet research, review and analysis of state regulations, licensure applications.
  • Strong computer skills, inclusive of Microsoft Office applications (Excel, Word, Outlook).
  • Written and verbal communication proficiency.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled