Credentialing Coordinator

Duration: 12+ Months

Job Overview:

The Credentialing Coordinator is responsible for initial credentialing and re-credentialing nurse practitioners, physician assistants and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.

Experience:

Responsible for the timely and accurate processing of all providers including NP’s/PA’s/MD’s initial and Re-credentialing applications according to the Clinic Provider Credentialing Program

• Monitor Expired licensure reporting, database tasks and maintain system updates and weekly reporting to leadership.
• Manage Epic access for any providers that have out of compliance licensure and/or board certification.
• Conduct sanctions and compliance monitoring and alert Credentialing Manager and Revenue Director of any undisclosed negative findings.
• Process malpractice insurance verification requests according to internal policies.
• Maintain the provider and physician SharePoint sites and Communicate provider statuses with leadership and other internal teams to meet timelines.
• Submit system access requests upon credentialing approvals/clinic eligibility.
• Support the payer enrollment team as needed to resolve any payer claim issues.
• Monitor Provider and Clinic change/Termination reports and update database accordingly.
• Process Name changes according to Clinic policies and procedures.
• Daily maintenance of provider credentialing grids with notification to appropriate teams
• Review and distribute all incoming mail as needed.
• Support Payer Audits in accordance with Clinic, Joint Commission and NCQA requirements.
• Maintain provider files with the most current information/documentation.
• Notify system analyst and leadership of any system and state agencies interruptions/updates/password changes.
• Make recommendations for process improvement and system efficiency.
• Attending and engaging in all team meetings.
• Model a positive attitude in interactions with team members.

Required Qualifications:

• Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expirable management.
• Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
• Ability to function independently and utilize critical thinking skills to accomplish goals and objectives.
• Effective communication skills; verbal and written.
• Strong interpersonal skills including the ability to work well with internal and external stakeholders.
• Strong organizational skills and the ability to multitask.
• Competent user of Microsoft Office, Outlook, Word, and Excel
• A minimum of 03 years’ experience in the healthcare industry with experience in credentialing

Professional Qualification: Required

• High School Diploma is MUST

Preferred Skills:

• NAMSS Certified Professional Credentialing Specialist (CPCS) certification - Preferred.