Credentialing Analyst / Coordinator

SGS_JOB_1319

Admin/Clerical
 Rhode Island
Microsoft Office
Outlook
MDStaff
Word
and Excel

Contract - 06+ Months Extendable

The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and require a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.

Job Responsibilities:

  • Responsible for the timely and accurate processing of all providers including NP’s/PA’s/MD’s Re-credentialing applications according to the Clinic Provider Credentialing Program
  • Monitor Expired licensure reporting, data base 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.
  •  
  • Analysts will work directly with other coordinators to ensure quality of work is delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis.
  • Conduct sanctions and compliance monitoring and alert Data Analyst Manager and Credentialing Manager of any undisclosed negative findings
  • Process malpractice insurance verification requests according to internal policies when applicable
  • 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 data base 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 Minute 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 efficiencies
  • Attend and engage in all team meetings
  • Model a positive attitude in interactions with team members

Skills:

  • Competent user of Microsoft Office, Outlook, MDStaff, Word, and Excel
  • A minimum of 3 years’ experience in the healthcare industry with experience in credentialing
  • NAMSS Certified Professional Credentialing Specialist (CPCS) certification
  • Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.

Education/Experience:

  • Associate or Bachelor’s Degree required

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