Associate Specialist, National Credentialing - Remote

JOB DESCRIPTION Job Summary Provides entry level support for Molina enterprise credentialing activities. Ensures that the Molina provider network consists of providers that meet all regulatory and risk management criteria - effectively minimizing liability to the company and maximizing safety for members. Responsible for initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations in the Molina network. Essential Job Duties u2022 Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals. u2022 Communicates with health care providers to clarify questions and request any missing information. u2022 Updates credentialing software systems with required information. u2022 Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals. u2022 Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants. u2022 Completes data corrections in the credentialing database necessary for processing of recredentialing applications. u2022 Reviews claims payment systems to determine provider status, as necessary. u2022 Completes follow-up for provider files on u2018watchu2019 status, as necessary, following department guidelines and production goals. u2022 Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions. u2022 Reviews and processes daily alerts for Medicare opt-out reports to determine if any provider has opted out of Medicare. u2022 Reviews and processes daily National Practitioner Data Bank (NPDB) continuous query reports and takes appropriate action when new reports are found. u2022 Maintains a high level of confidentiality related to provider information. Required Qualifications u2022 At least 1 year of experience in a data processing, production, and/or administrative role - preferably in a health care setting, or equivalent combination of relevant education and experience. u2022 Data entry skills. u2022 Self-direction and logical thinking abilities. u2022 Internet research experience. u2022 Ability to work cross-collaboratively in a highly matrixed organization with internal/external stakeholders. u2022 Effective verbal and written communication skills. u2022 Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications u2022 Health care industry experience. u2022 Production-related experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #PJHPO Pay Range: $21.65 - $34.88 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-02-09