Associate Specialist, National Credentialing

Job description

JOB DESCRIPTION Job Summary Provides entry level support for Molina enterprise credentialing activities. Ensures that the Molina provider network consists of providers that meet all regulatory and risk management criteria - effectively minimizing liability to the company and maximizing safety for members. Responsible for initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations in the Molina network. Essential Job Duties: - Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals. - Communicates with health care providers to clarify questions and request any missing information. - Updates credentialing software systems with required information. - Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals. - Collaborates with internal and external contacts to ensure timely processing or termination of recredenti...