Credential Administrator in Durham, NC at APEX Systems

Date Posted: 5/11/2018

Job Snapshot

Job Description

Job #:  848074

Our client is looking to hire a Credential Administrator for a six month contract (with possibility of extension) in Durham. If qualified, please email your resume to Sarah at

Job Description
-Responsible for building provider credentials file and making file determinations regarding required credentialing criteria based on general guidelines, ensuring compliance with all internal policies.
-Receives providers’ credentialing information and reviews assigned files for completeness and accuracy based on all policies and regulations.
-Initiate contact to providers for any additional supporting documentation or clarification. 
-Evaluates requests from providers to determine appropriate actions.
-Manage timely responses to external provider inquiries and requests.
-Educates providers on internal processes. 
-Conduct research for providers ensuring verification documentation is received and profiles are routed to appropriate team member.
-Prepares written correspondence to providers regarding status.
-Assists in researching pended and probated applications and resolving discrepancies. 
-Updates new information received in the credentialing database.
-Accurately prepare and image documents in appropriate areas of the credentialing database. 
-Support the execution of daily operating activities of the business area by performing various support activities as required by the specific business area. 
-Maintain and update paper and electronic/database files, scan paper records into electronic system and/or convert/compile data for departmental reports. 
-Research incorrect or missing information on claims, applications, medical records, surveys and/or correspondence. 
-Coordinate and/or record incoming and outgoing work as needed for business area including scheduling, supplies, reporting, tracking, monitoring and verifying receipt date and expected completion dates of outstanding work. 
-Type and generate letters, memos, envelopes and forms to support departmental needs. 
-May receive incoming calls from customers or providers and direct them to the necessary area. 
-May place outbound calls to verify information on claims, surveys, returned mail or other documents. 
-May receive inbound calls or place outbound calls to enroll and educate members in disease management or other health related programs. 
-May serve as the departmental Business Unit Coordinator (BUC). 
-May prepare and deliver work to go to the imaging department.
-Correct work that is returned from the imaging department. 

Must Have Requirements: 
• Background in health care administration with a focus on providers or experience in ensuring compliance with policies and guidelines. 
• Must be detailed oriented, work under deadlines and feel comfortable working in a production-oriented environment 
• Strong organizational skills which allow simultaneous completion of tasks 
• Oversee department workflow including mail, faxes, correspondence, and telephone calls, determining priorities, preparing responses, and/or responding appropriately without errors and in a timely manner. 
• Use standard software including Microsoft Word, PowerPoint, Excel, and Outlook. 

The “good to have” but, not

Job Requirements

• Experience building provider credentials file and making file determinations regarding required credentialing criteria based on general guidelines, ensuring compliance with all internal policies and NCQA, NCDOI and CMS guidelines - candidate will be trained if not
• Demonstrated ability to effectively communicate orally and in writing with both internal and external customers. 
• Proven skills required in verbal/written communication, organization, resourcefulness and decision-making. 

EEO Employer

Apex is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or 844-463-6178.