• Screening practitioner and facility applications and supporting documentation to ensure compliance with minimum credentialing criteria 
• Process practitioner and facility initial and re-credentialing activities in compliance with NCQA, state, and/or federal regulations and requirements, as applicable 
• Maintain excellent communications and strictly adheres to department processes between credentialing, provider relations and contracting 
• Maintains Credentialing database to ensure data accuracy 
• Ensure provider credentialing and re-credentialing is conducted in accordance with organizational policies and applicable government and regulatory agency standards and guidelines. 
• Maintains credential reports.
• Prepares agenda, documents, and minutes for the Credentialing Committee 
• Ability to perform monthly monitoring of NPBD and oversee sanctions process including but not limited to streamline verify 
• Effectively improve operational processes to achieve maximum efficiency. 
• Assists in the review of Credentialing policies and procedures. 
• Maintains confidentiality of all information in compliance with State and Federal law. 
• Communicate effectively with other professionals to achieve positive customer outcomes. 
• Promotes and contributes to a positive, problem-solving environment. 
• Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws. 
• Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations. 
• Participate in meetings, training and in-service education, as required. 
• Performs other duties as assigned.

• No

• At least one (1) year experience with credentialing in a health plan setting with Medicare/Medicaid experience preferred but not required 
• Provider network management or provider relations experience a plus 
• Knowledge of CMS/Medicare/Medicaid and NCQA credentialing requirements 
• Excellent customer service skills required 
• Excellent computer knowledge is required, including proficient knowledge of Microsoft Office 
• Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization 
• Ability to work effectively independently and in a team environment 
• Ability to read, analyze, and interpret technical procedures or governmental regulations 
• Ability to write reports, business correspondence, and procedure manuals 
• Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public 
• Ability to define problems, collect data, establish facts, and draw valid conclusions 
• Strong decision-making, analytical skills 
• Must be self-motivated, organized and have excellent prioritization skills 
• Must be able to work well under stressful conditions 
• Must be able to work in a fast-paced environment 
• Fluency in Spanish and English required

• The noise level in the work environment is usually moderate.
• Fast-paced office environment.
• Highly regulated environment.
• Time frames to handle issues are in accordance with CMS time frames.

This work requires the following physical activities: climbing, bending, stooping, kneeling, twisting, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours.

• Duties accomplished at the end of the day/month
• Compliance with Department Call Metrics/ Company Regulations
• Attendance/Punctuality
• Safety and Security
• Accuracy Rate

This Job Description may be modified at any time at the discretion of the employer as business operation may seem necessary. This does not constitute an employment agreement and may not include all duties. The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple competing tasks and demands and to seek supervisory assistance as appropriate.

Solis Health Plans provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.