Credentialing Coordinator

SGS_JOB_1953

Pharmacy
Remote
Microsoft Office
Outlook
Word
and Excel

Contract - 03+ Months

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.

Job Responsibilities:

  • 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 Minute 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.
  • 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 Minute 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:

  • Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expirable management.
  • Proficient in quantitative analysis
  • Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
  • Competent user of Microsoft Office, Outlook, Word, and Excel
  • A minimum of 3 years’ experience in the healthcare industry with experience in credentialing

Education/Experience:

  • Verifiable High School Diploma is required.
  • Associate/ Bachelor will work

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