GEHA
Credentialing Specialist
GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees. GEHA has one mission: To empower federal workers to be healthy and well. Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization. Administers the credentialing process via vendor network. Develops and creates reports for monitoring and tracking internal network processes and staff production in Salesforce. Works independently to coordinate, develop, monitor and maintain the credentialing process under the supervision of the Supervisor, Credentialing. Skills
Performs reviews of provider applications. Determines eligibility by applying GEHA's credentialing criteria and submits completed files to the Peer Review Committee and supervisor for approval and participation in the network. Attends Peer Review Committee and provides reports regarding provider application information. Analyzes and resolves provider file issues, tracks progress on vendor network management, and produces reports. Reviews and analyzes provider file changes. Responds to provider inquiries received by letter, phone, or from internal departments. Administers re-credentialing of network providers. Reviews and monitors provider complaint and grievance files. Assists supervisor with denied provider and quality assurance processes. Assists other team members as needed to maintain departmental TAT. Other duties as assigned. Requirements BS degree, additional years of analytic experience may be considered in lieu of education. Requires three - six years of experience in managed care or health insurance administration, business administration, sales/marketing, or account management. Requires effective verbal and written communication skills to communicate with providers and GEHA management staff. Candidates must reside in KC metro area. Work-at-home requirements Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you Competitive pay/salary ranges Incentive plan Health/Vision/Dental benefits effective day one 401(k) retirement plan: company match
dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution Robust employee well-being program Paid Time Off Personal Community Enrichment Time Company-provided Basic Life and AD&D Company-provided Short-Term & Long-Term Disability Tuition Assistance Program While this is a remote opportunity, at this time GEHA does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine. The annual base salary range for this position is $47,393 - $66,807 USD. GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.
GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees. GEHA has one mission: To empower federal workers to be healthy and well. Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization. Administers the credentialing process via vendor network. Develops and creates reports for monitoring and tracking internal network processes and staff production in Salesforce. Works independently to coordinate, develop, monitor and maintain the credentialing process under the supervision of the Supervisor, Credentialing. Skills
Performs reviews of provider applications. Determines eligibility by applying GEHA's credentialing criteria and submits completed files to the Peer Review Committee and supervisor for approval and participation in the network. Attends Peer Review Committee and provides reports regarding provider application information. Analyzes and resolves provider file issues, tracks progress on vendor network management, and produces reports. Reviews and analyzes provider file changes. Responds to provider inquiries received by letter, phone, or from internal departments. Administers re-credentialing of network providers. Reviews and monitors provider complaint and grievance files. Assists supervisor with denied provider and quality assurance processes. Assists other team members as needed to maintain departmental TAT. Other duties as assigned. Requirements BS degree, additional years of analytic experience may be considered in lieu of education. Requires three - six years of experience in managed care or health insurance administration, business administration, sales/marketing, or account management. Requires effective verbal and written communication skills to communicate with providers and GEHA management staff. Candidates must reside in KC metro area. Work-at-home requirements Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you Competitive pay/salary ranges Incentive plan Health/Vision/Dental benefits effective day one 401(k) retirement plan: company match
dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution Robust employee well-being program Paid Time Off Personal Community Enrichment Time Company-provided Basic Life and AD&D Company-provided Short-Term & Long-Term Disability Tuition Assistance Program While this is a remote opportunity, at this time GEHA does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine. The annual base salary range for this position is $47,393 - $66,807 USD. GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.