Fall River Health Services is looking for a Credentialing Coordinator to work under the supervision of our HR Manager. In this role you will perform duties at the professional level in some or all of the following areas: provider internal credentialing, provider insurance credentialing, facility insurance credentialing, telemedicine credentialing, and external credentialing verification requests.

Responsibilities:

• Establishes and maintains positive professional communications with the Medical Staff, Administration, all departments and related health agencies.
• Ensuring compliance with applicable laws, regulations, procedures, and policies.
• Responsible for timely processing of practitioner and organization/facility provider applications for credentialing and re-credentialing, requesting primary source documentation, processing documentation requirements, collecting information from the National Practitioner Data Bank (NPDB), malpractice insurer, verifying information received, updating information in the system of record, evaluating over all case categorization, and reporting findings to the Medical Staff, CEO, and the FRHS Board Credentialing committee.
• Credential all new providers with insurance companies, to ensure timely and correct insurance payments to the facility. Also includes tracking insurance credentialing, re-credentialing due dates, re-credential those providers on the schedules dictated by the different companies, communicate with billing department to resolve out-of-network issues, and stay current with process changes within each insurance company.
• Identify discrepancies in information and conduct follow-ups.
• Maintain listing of all licenses and expirations. Notify providers when licenses are nearing expiration.
• Maintain credentialing for telemedicine providers.
• Complete facility credentialing for insurance companies. This includes credentialing for the facility as a whole, and individual areas (hospital, clinic, long-term care, ED, etc.).
• Notify providers when privileges have ended.
• Maintain and improve credentialing software.
• Complete provider affiliation verification and provide other information for outside organizations.
• Assist with special projects as needed and other duties as assigned.

The average Salary for this position is $19.61- $23.90 an hour depending on years of experience.