Job Title: Credentialing Specialist

Job Description

As a Credentialing Specialist, you will be primarily involved in three main parts or phases of a project. Your responsibilities will include: Implementing Visual Cactus, ensuring its compliance with data entry policies, assisting with tasks such as data validation, user acceptance testing (UAT), workflow review and creation of workflow documentation. Your core functions will involve initial credentialing and re-credentialing, which includes conducting annual audits for current Sub-Delegation Credentialing Agreements, assisting with the entry of information into Credentialing Spreadsheets to ensure data accuracy and up-to-dateness, entering providers into Visual Cactus, assisting with processing Initial and Re-credentialing files, managing Health Plan Rosters, entering data on Anthem Blue Cross Provider Add/Change/Term Roster template and Site Creation Forms. Moreover, you will also be tasked to perform Pre-Delegation Audits for Credentialing Sub-Delegation Agreements.

There will be 3 main parts/phases of this project and the responsibilities will encompass the duties below in each phase:

CACTUS Implementation:

● Review Credentialing Spreadsheets to ensure compliance with Visual Cactus Data Entry Policies

● Assist with implementation tasks in Visual Cactus such as data validation, UAT and workflow review and creation of workflow documentation

Core Functions: Initial Credentialing and Re-Credentialing

● Annual Audits for current Sub-Delegation Credentialing Agreements

● Assist with entering information into Credentialing Spreadsheets to ensure data is accurate and up to date

● Entering Providers into Visual Cactus

● Assist with processing Initial and Re-credentialing files

● Health Plan Roster Validations/Roster Management

● Entering Data on Anthem Blue Cross Provider Add/Change/Term Roster template and Site Creation Forms

Pre-Delegation Audit (Pre-requisite for Sub-Delegation Agreement between DHMSO and DHMF)

● Perform Pre-Delegation Audit for Credentialing Sub-Delegation Agreement

Hard Skills

• Visual Cactus

• Credentialing

• Roster Management

Job Type

This is a contract position with a duration of 6 Month(s).

Work Site

This is a fully remote position.

Work Environment

You will be working remotely from Monday to Friday, 8am-5pm PST. You will be supporting two teams consisting of seven Credentialing Specialists and Managers.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.