Credentialing Assistant

JOB SUMMARY

The Credentialing Assistant supports the Credentialing team with screening reviewers for required credentialing and background information, including professional sanctions and criminal background information. The Credentialing team coordinates between multiple departments at Dane Street to provide support in reviewer credentialing.

Credentialing Assistants operate web-based applications throughout the workday. Attention to details in information, communication, and data are required. The Credentialing Specialist may or may not be responsible for the duties listed below. The position reports to the Director of Legal, Compliance, and Regulatory Affairs and supports the department as needed.

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

Initial Credentialing: Enters reviewer application data, performs online searches of reviewers, conducts primary source verification of reviewer board certifications, licenses, background checks, and malpractice checks. Uploads documents to the electronic reviewer file, produces Judgments page to include comments from the Medical Director. Applies client Do Not Use status as required. Communicates the application status with the Credentialing Team Lead.

Outreach to On-Panel Reviewers: Initiate regular communication with on-panel reviewers to obtain and update contact information and locations. Manage retirement notifications and update reviewer status as necessary. Offer reactivation options to inactive reviewers. Conduct Critical Mention and Google searches.

Updating Expired Licenses, Board Certifications, and Workers’ Compensation Registration: Assists the Credentialing team with the review of licenses, certifications, and registrations for expiration status.

Exclusions, Preclusions, Background and Sanction Checks: Assists the Credentialing Team Lead with the creation of and receipt of sanctions checks, clearinghouse reports, and searches for each sanction identified. Finds supporting documentation, including court documents or National Practitioner Data Bank reporting. Sends information to the Medical Director for review.

Reactivating, Deactivating, Do Not Use, Reviewer Contact Data and W9 Requests: Assists the Credentialing team with gathering of W-9 documents in response to reviewer address changes. Clones profiles in the event of a fundamental identifying data change. Removes reviewers from the panel based on client or Operations department requests.

Editing Fee Schedules: Assists the Credentialing team with data entry of new fees or updated fees. Obtains new fee agreements as appropriate.

Other duties & special projects, as assigned and based on business needs.

Requirements

EDUCATION/CREDENTIALS:

An Associate’s Degree is preferred.  

JOB RELEVANT EXPERIENCE:

Business experience in a healthcare and/or insurance setting is preferred.         

JOB RELATED SKILLS/COMPETENCIES:

Present exceptional communication skills with a clear understanding of company business lines.  The ability to apply critical thinking, manage time efficiently and meet specific deadlines.  Computer literacy and typing skills are essential.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above.  Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services. 

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.

Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.

Our Commitment:

We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.

Compensation Range: $16.00 - $18.00/ hr USD

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. 

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.