Credentialing Coord Ii Jobs

We’re looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together. These core values embody our diverse and inclusive culture and help us live out our mission of “getting people the care they need when they need it.” Over the last 30 years, our company has established itself as the market leader in managed care for the workers’ compensation industry. We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.

Salary Range: $19.04 - $28.56 Hourly

This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $19.04 - $28.56 Hourly

Benefits Summary

In return for your commitment to our company’s mission, we offer a vast array of benefits to help support the whole you.

• Opportunities to work from home
• Enterprise Recognition Program rewarding colleagues for their extraordinary work
• Generous paid time off, 8 company holidays, and 2 floating holidays per year
• Healthcare concierge
• Paid development hours to use for professional and community development!
• Company paid life insurance
• Medical, dental, and vision insurance
• Pre-Tax FSA and HSA health savings accounts
• Colleague Assistance Program that provides free counseling and financial services
• $1,000 Colleague Referral Program
• The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.
• Tuition Reimbursement Program including certifications
• Referral program
• Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions
• Exclusive discounts on travel, activities, and merchandise via work discount program
• Company paid short term and long-term disability
• Competitive wages with opportunities to earn annual merit increases
• 401(k) matching

The Credentialing Coordinator II is responsible for ensuring that Primary and Secondary Source Verifications are appropriately collected and validated in support of the Initial Credentialing and Recredentialing processes within their assigned product line. Provides timely and accurate accounting and analyses of a Provider’s application information provided against the verifications received. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, and One Call policies and protocols, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing.

General Duties & Responsibilities

CREDENTIALING: 40%

• Performs detailed and thorough review in analysis of the application and supporting documents received by the Provider for completeness in comparison and reconciliation with the verifications collected. Informs the Provider of status, including requests for additional information or documents needed, or accounting for any discrepancies identified.
• Compiles electronic files, evaluates, and presents the completed provider file for review and preparation for presentation to the decision-making body.
• Recognizes, investigates, and validates discrepancies and adverse information obtained.
• Performs all Primary and Secondary Source Verifications for assigned product lines.

COMPLIANCE: 45%

• Identifies, monitors, and reports adverse actions, sanctions, and complaints against the provider in accordance with applicable law, One Call policy.
• Facilitates priority appeals and efficient due process that complies with One Call’s fair hearing and appeals policy as well as applicable legal and regulatory requirements.
• Uniformly apply clearly defined credentialing protocols to all providers for compliance regarding timeliness and accuracy.

ADMINISTRATIVE: 15%

• Complete outreach to providers in accordance with the outreach schedule both telephonically and electronically.
• Maintains appropriate status and notes in the credentialing database.
• Maintain continuous, consistent data integrity to ensure that accurate and current information is available to all systems and departments.

Educational And Experience Requirements

• At least 3 years’ experience directly related to conducting Primary and Secondary Source verifications in support of Initial and Recredentialing processes for healthcare providers/practitioners.
• Experience with computer systems required, including web-based applications and Microsoft Office applications which include Outlook, Word, Excel, PowerPoint, and PDF
• High School diploma required. Some college preferred.

General Knowledge, Skills & Abilities

• Patient and Customer Focused: ability to put yourself in our patient’s and provider's shoes. Commitment to Patient safety and Positive Provider Engagement Experiences.
• Requires proficient negotiation skills and tactics, both written and verbal.
• Quality of Work: freedom from errors and mistakes with the ability to consistently meet objectives; high attention to detail.
• Exercise independent thinking and judgment.
• Work collaboratively and relate effectively to others by practicing, valuing, and embracing diversity of individuals, and fostering respect and equity in the workplace.
• Maintains compliance with One Call’s established credentialing processes and protocols. Meets client expectations and department timeliness commitments. Complies with Accreditation and Regulatory Standards in addition to compliance with State and Federal Accreditation Standards and Regulatory Requirements.
• Ability to express thoughts clearly, concisely, and effectively both verbally and in writing. Excellent verbal and written communication skills as well as listening skills and reading and writing comprehension to technical and non-technical audiences of various levels within the organization (e.g., executive, management, individual contributors).
• Encourage and facilitate cooperation, trust, and group identity; and builds commitment, team spirit, and strong relationships.
• Commit to continuous performance and process improvement.
• Performs other related duties as assigned.
• Self-starter with experience handling high work volume and multiple projects.
• Demonstrates active listening and gives full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, not interrupting at inappropriate times, understanding the implications of new information for both current and future problem-solving
• Value and model integrity and honesty by acting in a just, fair, and ethical manner an encouraging ethical behavior among others. Inspire trust and confidence among stakeholders through reliability, authenticity, and accountability.
• Display a credible presence and positive image when representing One Call.
• Strategic Perspective: understands the position of the organization with a global context. Able to anticipate future trends, consequences, and opportunity-costs, and to map a clear path of acceleration toward strategic opportunities.
• Ethical conduct and the ability to respect and preserve confidential information entrusted in the course of professional duties is necessary. Reveals confidential information only to appropriate parties and in accordance with any applicable law. Maintains confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
• Ability to establish and maintain positive relationships with internal and external customers and be a team player.
• Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills.
• Excellent problem solving, time management, and work prioritization skills.
• Ability to think and work effectively in a high-pressure environment. Comfortable with change and possesses the ability to switch tasks and priorities seamlessly. Ability to adapt behavior in response to new information or changing circumstances. Is open to change and new information, ideas, methods, or approaches. Work and collaborate effectively and adjusts to original objective or plan to allow for the best possible results.
• General knowledge of the U S Healthcare system and workers compensation industry.

Physical/Emotional Demands & Work Environment

The Physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus.
• Ability to work long hours – over eight in a workday, and over 40 in a work week as necessary. Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position.
• The work environment utilizes florescent lighting; noise level is moderate.
• Please be advised this job description is subject to change at any time.
• The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.
• For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.
• The employee is occasionally required to stand, walk, and lift objects (up to 10 lbs. weight; up to 4 ft. height).

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Job Snapshot

Employee Type

Full-Time

Location

Jacksonville, FL (Remote)

Job Type

Other

Experience

Not Specified

Date Posted

07/07/2023