Credentialing Coordinator

Work Location Requirement:

• If the candidate lives within 40 miles to the office on Valley View Lane, they will be required to come into the office every other Tuesday, resulting in twice a month.
• If they are greater than 40 miles from the office they will be fully remote.

Job Summary:

• The Credentialing Coordinator role will be responsible for ensuring all providers have the necessary requirements and are approved to participate in the application client health plans.
• S/He will maintain strong cross-departmental relationships with Recruiting, Production, and Education.
• This role will report to our Manager of Credentialing.

Essential Function:

• Review and screen initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local, and NCQA regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and Client Health criteria, while maintaining the confidentiality of all protected health information that may be accessed.
• Identifies analyzes and resolves extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact the ability to credential and enroll practitioners; discovers and conveys problems to Credentialing Manager/Supervisor/Director.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Enters, updates, and maintains data from provider applications into the credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses and in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks, and follows up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Communicates clearly with providers, internal/external clients, and all Client Health staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest developments to enhance understanding of various regulations and legislation of the healthcare industry and assist with special projects on an as-needed basis.

Qualifications:

• Successful work experience in a credentialing role.
• NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) or within 2 years of eligibility to certify (Preferred).
• CAQH Experience (Preferred).
• MD Staff Experience (Preferred).
• Google Suites Experience (Preferred).