Remote Opportunity

Schedule:

Monday-Friday

PRIMARY FUNCTION

The Credentialing Coordinator is responsible for organizing, maintaining, verifying, privileging of all aspects of the credentialing process, and maintenance of current provider files including enrollment activities. The coordinator should have a high level of accuracy and integrity as they ensure provider certifications and files are maintained up to date.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

Obtains timely and accurate primary source verification for initial credentialing and recredentialing functions of providers who work in office or via telemedicine. Responsible for maintaining and updating provider expirable, such as but not limited to malpractice insurance. Licenses, DEAs, board certification. Maintains current database for providers and updates applicable software/system.

Performs detailed analysis of application and information obtained during primary source verification process. Critical thinking and analysis of this information is crucial to initially determining the credibility of providers. Identify any discrepancies with any credentialing documentation and history. Escalates significant credentialing discrepancies to the manager.

Responsible for initial provider enrollment with payers that do not have a delegated credentialing agreement. This includes all requirements for Medicare/Medicaid as applicable. Responsible for provider re-validation/recredentialing applications with payers that do not have a delegated credentialing agreement..

Responsible completing required documents/applications for credentialing/recredentialing and privileging providers at hospitals where they are assigned to round.

Completes, updates and maintains provider CAQH data as needed.

Research skills to do primary source verification.

Provides exceptional customer service to providers, administration, and executive staff, as well as external contacts.

Assists other regions when needed.

QUALIFICATIONS

EDUCATION:

Minimum of High school diploma or equivalent required.

An associate degree from an accredited institution preferred.

3 years of related experience is commensurate education required.

EXPERIENCE:

Minimum 2 years of credentialing experience preferred.

LICENSURE / CERTIFICATION

Certified Provider Credentialing Specialist (CPCS) preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

Presenting written and oral information in an accurate, clear, succinct, and understandable manner using correct grammar and logical flow of ideas; adapting communication style and tone to fit the situation and engage the audience.

Meticulously keeping track of details without becoming overwhelmed by them; being exacting, precise, and accurate; spotting minor imperfections or errors and taking action to correct them.

Identifying the optimal solution using principles of evidence-based practice to integrate best practice, research, evidence, and job organization, and/or industry expertise with the needs and requirements of the situation.

Being open to change and considerable variety in work activities; effortlessly adjusting to new or changing situations and unexpected events; altering one’s approach to tasks and projects with minimal loss of efficiency.

Using inductive and deductive reasoning to formulate general rules or principles and apply them to work; identifying flaws in logical reasoning; understanding complex conceptual relationships; accurately detecting underlying themes or patterns in data.

Taking an organized approach to work and planning; identifying objectives aligned with business strategies, structuring work, and estimating necessary time and resources; anticipating and adjusting for potential obstacles and problems; monitoring work progress.

Listening to and recognizing the challenges and perspectives of others; sharing information and resources; working cooperatively with others to seek common ground and achieve group goals; proactively adjusting one’s style and efforts to complement those of others on the team; valuing organizational success as much or more than individual success.

Proficiency with computer skills with a focus on Word and Excel.

Working knowledge of NCQA, AAAHC, state and federal rules/regulations

Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately.

Ability to analyze situations accurately and adopt effective courses.

Works independently and is self-directed.

Demonstrate skills in attention to detail, organization, prioritizing and multi-tasking.

Credentialing software knowledge a plus.

TYPICAL WORKING CONDITIONS

Non-patient facing

May be either full time remote/telework or rotate working in the office and remote/telework.

This job must be U.S. based.

Indoor

Operating Computer

Reach Outward

Manual Dexterity

Lift/Carry 10lbs or less

Sitting

Traveling

Bending

OTHER PHYSICAL REQUIREMENTS

Vision

Sense of sound

Sense of touch

PERFORMANCE REQUIREMENTS

Adherence to established standards as mandated by NCQA, AAAHC, state and federal rules/regulations is required.