Job description

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

Position Summary:

Initiate, maintain and monitor AlohaCare’s credentialing processes to ensure conformance with established department and organizational policy and procedures, national accreditation standards, and contractual state and federal requirements within expected timeframes.

Primary Duties & Responsibilities:

• Performs all AlohaCare credentialing processes and activities to ensure QUEST integration and Advantage Plus (CMS SNP) network adequacy requirements are met which include Individual Providers/Practitioners; Facilities; Long Term Services and Support (LTSS) providers credentialing for contracting purposes.

• Perform verification of credentialing information and complete primary source verification activities as needed.

• Performs internal audits of credentialing file reviews for quality assurance purposes

• Prepares, organizes and maintains assigned credentialing files along with relevant documents to support credentialing processes within expected timeframes.

• Assists with coordination and preparation of assigned credentialing files for committee meeting presentation, review and determination.

· Contributes to the development and revisions of applicable workflows and processes to support department and organizational business needs.

• Performs data entry, maintains and monitors credentialing database to support day-to-day operations of credentialing activities.

• Communicates, both verbally and in writing with providers, administrators and their staff members regarding credentialing activities and processes.

• Assists the Provider Relations, Credentialing and Contracts teams with credentialing inquiries providing responses and resolution in a timely manner.

• Collaborates and communicates with the Provider Relations and Contracts Team relative to Credentialing projects and activities.

• Responsible to maintain confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees are granted access to AlohaCare’s owned and subcontracts data bases with specific data classifications assigned to this job title

· Other credentialing duties as assigned to support department business needs.

Required Competencies & Qualifications:

• High School Diploma

• Minimum of 1-year Provider and Facility Health Plan credentialing experience

• Minimum of 1-year Administrative and/or clerical experience

• Minimum of 1-year Customer Service experience

• Strong verbal and written communication skills

• Proficient in Microsoft Office products; Word, Excel, Outlook and Power Point

• Proficient use and experience with Adobe products and programs

• Excellent attention to detail

• Problem solving and active hearing and listening skills a must.

• Ability to multi-task, handling varied responsibilities

• Ability to prioritize and organize daily activities

• Strong interpersonal and customer service skills

• Flexibility and adaptability to changing priorities

Preferred Qualifications:

• Associates Degree Preferred

• National certification as credentialing specialist (highly desirable)

Physical Demands/Working Conditions:

• Operation of computer workstation, including keyboard and video display terminal.

• Operation of office equipment, mitel phone system, efax, Xerox printer/copy machine.

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

Job Type: Full-time

Pay: From $16.50 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Honolulu, HI 96814: Reliably commute or planning to relocate before starting work (Required)

Experience:

• provider and facility health plan credentialing: 1 year (Required)
• customer service: 1 year (Required)
• administrative and/or clerical: 1 year (Required)

Work Location: One location

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