The
Credentialing Specialist III is a junior member of the Quality department’s leadership team. The primary responsibilities of this position include the auditing of credentialing and re-credentialing files, performing the pre-delegated and annual oversight audits for those provider groups with delegated credentialing, assisting in the training needs of department staff, and drafting departmental policies and operating procedures, and support any third-party audits requiring credentialing information.
You will
- Be responsible for conducting pre-delegation and annual file audits for all delegated provider entities according to guidelines and preparing a report of findings for review by Credentialing Committee.
- Perform final step in credentialing/re-credentialing process to ensure accuracy and completeness of provider file before presenting to Credentialing Committee.
- Evaluate if provider file satisfies departmental policies as "clean" or "needs review" and build essential documents for the Credentialing Committee.
- Assist management in preparing for the health plan and SOC1 audits.
- Works with management to draft desktop procedures as needed.
- Review existing departmental policies and procedures annually and works with management to make updates as needed.
- Assist management with training needs within the department.
- Performs special project work as assigned.
- Actively mentors and develops team members to meet department productivity and quality standards.
- Cultivates a culture where diverse thoughts, experiences, and backgrounds are valued. Continuously strives to provide outstanding products and customer service.
- Demonstrates self-awareness and embraces feedback.
You have
- 3+ years' of relevant credentialing experience in a managed care setting Expert knowledge of NCQA guidelines recommended Proficiency in computer and software programs (e.g., MS Word, Excel, Share Point) Ability and desire to embrace change, while maintaining a high level of productivity.
- A dedication to excellence, strong interpersonal, oral, and written communication skills required Critical thinking, detail-oriented and strong organizational skills required Excellent interpersonal, oral, and written communication skills required. Critical thinking, detail-oriented and strong organizational skills required.
- Bachelor’s degree preferred or equivalent experience.
- PCS certified preferred.
- Experience working with Cactus system desired.
- Experience with delegated credentialing audits is highly desirable
- Knowledge of the dental industry desired.
- Proven leadership behaviors.
Location and Travel
This is a flexible position requiring 2 days per week in the office, with preference given to candidates within commuting proximity to a Guardian office. This position may require occasional travel to perform delegated audits onsite, as needed.
Salary Range
$35,600.00 - $53,405.00
The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.
Our Promise
At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
Inspire Well-Being
As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.
Health Care
- Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits
- Dental plan
- Vision plan
- Health care accounts – flexible spending, health reimbursement, and health savings accounts
- Critical illness insurance
Life and Disability Insurance
- Company-paid Life and Disability insurance plus voluntary supplemental coverage
- Accident insurance
Retirement and Financial
- 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable
- Complimentary 1:1 financial guidance with a licensed Fidelity representative
Time Off and Remote Work
- Flexible work arrangements (part in-person/part remote)
- Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement
- Personal holidays for colleagues to use in recognition of religious, cultural, or civic days
- Paid parental leave and paid family and medical leave policies
Emotional Well-being and Work-Life
- Emotional well-being, mental health, and work/life resources powered by Spring Health
- Wellness programs, including fitness program and equipment reimbursement
- Child, adult, and elder back-up care support through Bright Horizons
- Adoption assistance
- College planning
- Tuition reimbursement
- Student loan assistance
- Commuter benefits in select metropolitan areas
Equity & Inclusion
Opportunities to build inclusive and meaningful connections through involvement in colleague-led affinity groups:
- Employee Resource Groups:
- Colleague Connection Committees
- Community Involvement Committees
A culture that encourages colleagues to bring their authentic selves to work
- Voluntary self-ID
- Pronunciation and phonetic spelling of names
Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.
Equal Employment Opportunity
Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.
Accommodations
Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact applicant_accommodation@glic.com.
Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.