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Credentialing Representative
Highmark Health. Process provider applications and re-applications, including initial mailing, review and loading .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider credentialing processes, including data management and compliance with URAC standards. Proficient in Microsoft Office and experienced in managing complex provider information and customer service inquiries.
Highest-signal resume keywords
Provider Data ManagementCredentialing ProcessesMicrosoft Office SuiteULTRA System ExperienceHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CredentialingProvider File ManagementData Security GuidelinesClaims ProcessingReport CreationDatabase MaintenanceProject ManagementAudit SupportCommunication with ProvidersTraining Personnel
Soft Skills
Written CommunicationVerbal CommunicationDiplomacyProfessional DemeanorPresentation Skills
Tools & Technologies
Dental Provider File SystemCustomer Service Inquiry Systems
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
URAC StandardsCredentialing InventoryProvider CredentialingComplianceData Management
About the role
Key responsibilities & impact- Process provider applications and re-applications, including initial mailing, review and loading
- Maintain the provider database
- Communicate with providers by phone and mail regarding credentialing status and information
- Perform credentialing, re-credentialing and related activities
- Coordinate credentialing verifications
- Review and process complex additions, updates and deletions of provider information in the Dental Provider file database
- Support implementation of new networks, systems, software, guidelines and other initiatives, focusing on group practices
- Train credentialing personnel depending on level
- Manage credentialing inventory, reports and projects to meet established timelines
- Create and distribute monthly reports
- Handle complex, unusual and high-level credentialing issues
- Support projects, audits, business partners, internal departments and external clients
- Represent the department as the subject matter expert
- Research and pull documentation for audits
- Provide customer oversight for unique requirements and timelines
- Investigate interim license actions depending on level
- Participate in projects that streamline, automate or enhance credentialing functions
Requirements
What you’ll need- High School Diploma or GED
- 3–5 years of related, progressive experience
- Experience in Provider Data Management, Customer Services or Claims
- Microsoft Office experience, including Word, Excel and PowerPoint
- Familiarity with credentialing processes and URAC standards
- Experience with ULTRA and Dental Provider File systems
- Experience with Customer Service inquiry systems or claims processing concepts
- Good written and verbal communication
- Proficiency in provider file use and provider credentialing
- Proven diplomacy and professional demeanor
- Strong written communication and presentation skills
- Compliance with HIPAA, data security guidelines, company policies, applicable laws and regulations
Benefits
Comp & perks- Base pay of $20.72–$30.12 per hour
- Remote work arrangement
- No travel required