Specialist, CC Provider Services – Remote

This position is responsible for the timely completion of Medicare and Medicaid applications for new and existing providers, reviewing, and verifying information for Care Connections providers for submission to Molina’s Corporate Credentialing Department, and other administrative tasks.

Knowledge/Skills/Abilities

• Collects, reviews, and verifies all required documentation, licenses, certifications, and credentials from Care Connections providers for all states where services are provided.
• Monitors and tracks expiration/renewal dates of credentials/licenses and proactively works with clinicians to obtain updated documentation as needed.
• Maintains an up-to-date provider tracker and database of provider information.
• Follow-up, investigate, and resolve credentialing and enrollment issues, discrepancies, and denials promptly, collaborating with internal teams and stakeholders, as needed.
• Prepares and submits enrollment applications to Medicare and Medicaid for new and existing providers and follows up by telephone or in writing regarding application status, as needed.
• Serves as a delegate for clinician applications. Coordinates with clinicians as needed to resolve any discrepancies.
• Prepares, distributes, and ensures completion of Nurse Practitioner and Supervising Physician provider agreements promptly according to standardized processes.
• Submits requests and follow up to claims payment systems QNXT/MAPD.
• Offboarding providers to ensure timely processing or termination.
• Cross-licensing clinicians in multiple states (Credentialing and Medicare/Medicaid enrollment)
• Analyze reporting to validate supervising physician chart reviews are completed and timesheets are submitted for payment.
• Provide concise, timely communication to appropriate leadership regarding potential credentialing and enrollment issues.

Job Qualifications

REQUIRED EDUCATION:

High School Diploma or GED

Required Experience

• 1-3 years of experience with credentialing providers.
• Knowledge of credentialing standards, regulations, and best practices.
• Experience in Medicare and Medicaid enrollment.
• Experience researching Medicare and Medicaid regulations and requirements.
• Strong attention to detail, ability to multi-task, prioritize tasks, meet deadlines, and demonstrate attention to detail and follow through in a fast-paced environment.
• Utilize critical thinking skills to identify issues, problem solve to logical conclusion and demonstrate initiative.
• Excellent written and verbal communication skills.
• Demonstrate positive working relationships with peers and effectively manage conflict.
• Demonstrate personal responsibility and accountability by meeting attendance and schedule adherence expectations.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Proficient in Microsoft Office Suite.

Preferred Education

Associate or bachelor’s degree