Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria in order to minimize liability to the company and to maximize safety for members.
Working in partnership with the Credentialing Supervisor or Manager, serves as a team lead for corporate credentialing staff. In addition, may also be assigned responsibility for supporting regular meetings of the Credentialing Committee on behalf of the Molina state health plans.
• Oversees the day-to-day operations of the team, directs work, ensures turn-around time requirements are being met and monitors quality of work by conducting regular audits and tracking results.
• Guides and answers questions from lower-level staff and assists with questions and interdepartmental issues to help coordinate problem solving in an efficient and timely manner.
• Supports and implements large scale department projects
• Provides credentialing subject matter expertise when working with other departments and functions.
Prepares for and participates in credentialing audits
Develops job aids and standard operating procedures
• May schedule and prepare supporting documentation for regular meetings of a health plan's Credentialing Committee according to current policies, procedures, and regulatory standards. Attends and documents meeting minutes; conducts needed follow-up after meetings; and documents and communicates decisions to providers.
Bachelor's Degree (equivalent combination of education and experience may be considered in lieu of degree).
• Minimum of 3 years experience in credentialing.
• Experience in a production or administrative role requiring self-direction and critical thinking.
• Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems.
• Experience with advanced written and verbal communication.
• Required knowledge of CMS, NCQA and other credentialing regulations.
Required License, Certification, Association
Certified Provider Credentialing Specialist (CPCS) or participation in a CPCS progression program.
Bachelor's Degree in a related field.
Previous experience leading, guiding or mentoring others.
Preferred License, Certification, Association
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Apply on company website