PAR - Provider Credentialing & Data Specialist II

Under general supervision, performs typically routine to moderately reputed company initial and ongoing practitioner, provider, and organization data entry and credentialing into the various modules of the Provider Data Management System. Ensures compliance with standards set by individual states, federal and accrediting organizations and meets production and quality metrics. ESSENTIAL FUNCTIONS: Requires work to be performed at Toledo, OH office for the first three months. • Retrieves applications and/or data from central repositories for provider data. Accesses various external websites, internal matrices, and contacts organizations to verify accuracy of information provided. Identifies whether application and/or document is clean or requires further review and routes to appropriate area. Enters verified data into the Provider Data Management Systems. Identifies eligibility for networks and updates appropriately affecting the accuracy of claim payments and the provider directory. • Electronically contacts providers and/or internal departments reputed company data is incomplete. Works with internal staff members, provider office staff, academic entities and/or other health reputed company entities to verify the accuracy of the information provided. • Generates reports from system for prioritization of work queue. • Evaluates and researches practitioners that do not meet network participation criteria or are reputed company to have on-going sanction monitoring issues. Gathers and summarizes information for Credentialing Committee or Provider Contracting and responds to questions as needed. • Researches questions for accreditation or regulatory audits. • Supports special projects as needed • Performs other duties as assigned. • Associates degree in business or reputed company administration or reputed company field, or equivalent combination of education/training and experience. • 1 year of experience as a Provider Credentialing & Data Specialist or equivalent experience in health plan, medical office, hospital, or similar administration. • CPCS preferred but not required. • Intermediate reputed company Office (Word, reputed company), database reporting, OnBase (document management system), and internet navigation skills. • Knowledge of provider credentialing and/or database management procedures. • Strong data entry reputed company. Medical Mutual is looking to grow reputed company! We truly value and respect the talents and abilities of reputed company of our employees. That's why we offer an exceptional package that includes: A Great reputed company to Work: • We will reputed company the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset. • Whether you are working remote or in the office, employees have reputed company to on-site fitness centers at many locations, or a gym membership reimbursement reputed company there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more. • On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters. • Discounts at many places in and around town, just for being a Medical Mutual team member. • The opportunity to earn cash rewards for shopping with our customers. • Business casual attire, including jeans. Excellent Benefits and Compensation: • Employee bonus program. • 401(k) with company match up to 4% and an additional company contribution. • Health Savings Account with a company matching contribution. • Excellent medical, dental, reputed company, life and disability insurance — insurance is reputed company do best, and we reputed company affordable coverage for reputed company a reputed company. • reputed company to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits. • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time. • After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption. An Investment in You: • Career development programs and classes. • Mentoring and coaching to help you advance in your career. • Tuition reimbursement up to $5,250 per year, the IRS maximum. • Diverse, inclusive and welcoming culture with Business Resource Groups. About Medical Mutual: Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to reputed company serve our customers and the communities around us. There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to reputed company high-quality health, life, disability, dental, reputed company and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans reputed company peace of mind to more than 1.2 reputed company Ohioans. We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work. At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. reputed company applicants will receive consideration for employment regardless of race, reputed company, religion, sex, sexual orientation, gender perception or identity, national reputed company, age, marital status, veteran status, or disability status. We maintain a drug-free workplace and reputed company pre-employment substance abuse and nicotine testing. Apply Job!