Overview
Molina Healthcare is seeking a detail-oriented Credentialing Specialist to join our team. The Credentialing Specialist ensures that Molina’s provider network meets all regulatory, compliance, and risk management standards. In this role, you’ll handle initial credentialing, recredentialing, and ongoing monitoring of sanctions and exclusions for healthcare practitioners and organizations. The ideal candidate is highly organized, detail-focused, and committed to maintaining confidentiality while supporting the safety and quality of care for Molina members.
Key Responsibilities for Credentialing Specialist
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Review and evaluate credentialing applications for accuracy and completeness based on provider specialty.
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Obtain necessary verifications in compliance with Molina policies, procedures, and regulatory requirements.
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Communicate with providers to clarify questions and request missing documentation.
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Update credentialing databases and software systems with required provider information.
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Request and follow up on recredentialing applications while adhering to production goals.
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Collaborate with internal and external teams to process recredentialing applications efficiently.
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Review claims payment systems to determine provider status when needed.
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Track providers on “watch” status and complete follow-ups as required.
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Monitor daily alerts for federal/state sanctions, exclusions, Medicare opt-out reports, and NPDB Continuous Query reports, taking action as necessary.
Required Qualifications
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High School Diploma or GED.
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Experience in production or administrative roles requiring critical thinking and self-direction.
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Proficiency with computers, including internet research, Microsoft Outlook, Word, and other software systems.
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Strong professional written and verbal communication skills.
Preferred Qualifications
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Experience in the healthcare industry.
Why Join Molina Healthcare
Molina Healthcare offers competitive compensation, comprehensive benefits, and opportunities for career growth. We are an Equal Opportunity Employer (EOE), committed to diversity, equity, and inclusion.
Pay Range: $21.16 – $34.88 / Hourly (varies by location, experience, and qualifications)