Credentialing Coordinator

Position Overview

MetroPlusHealth is seeking an individual to join our Credentialing Department in the capacity of Credentialing Coordinator. This position is responsible for credentialing of new providers including Behavioral Health providers & facilities, re-credentialing, and processing provider demographic updates and changes. The Credentialing Coordinator is responsible for document collection, review, verification, and provider credentialing file maintenance. This position also ensures that all credentialing supporting documentation is confidential and maintained in a secure environment. Lastly, the Credentialing Coordinator assists facilities and providers in understanding and adhering to MetroPlusHealth’s policies and procedures regarding the credentialing process/provider information update.

Scope Of Role & Responsibilities

• Maintain communication with the credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and update of provider credentialing information
• Review provider re-credentialing and credentialing file for completion and presentation to the Credentialing Committee.
• Perform primary source verification on required elements and in accordance regulatory guidelines and MetroPlusHealth’s policies and procedures
• Data entry and upkeep of provider information in the credentialing and other pertinent databases
• Verify New York State OPMC, Medicare/Medicaid lists and other pertinent databases for any current sanctions, restrictions on licensure and/or limitations on the scope of practice on all credentialed providers in interim credentialing periods
• Verify New York State license registration and DEA registration status for all credentialed providers in the interim credentialing periods
• Generate and disseminate monthly provider credentialing updates to appropriate departments at MetroPlusHealth and participating facilities and provider groups
• Review and respond to request for credentialing information/copies of credentialing files to appropriate departments within MetroPlusHealth
• Generate and disseminate provider rosters to delegated facilities, contracted group practices etc.
• Perform provider roster reconciliation
• Create, copy, file, and maintain all relevant documentation into provider credentialing folder.
• Maintain confidentiality of provider credentials by filing the credentialing folder in respective cabinets in the file rooms.
• Perform annual delegated file audits and participate in pre-delegation and delegation site reviews
• Respond to inquiries from other MetroPlusHealth departments relative to a provider’s credentialing status
• Performs other related tasks as directed by the Deputy Chief Operating Officer or her designee, the Credentialing Director or Credentialing Team Lead.
  
  
  

Required Education, Training & Professional Experience

• Highschool Degree required; Bachelor’s Degree preferred
• 3 years of previous experience with provider credentialing processes and procedures
• Knowledge of CACTUS preferred
• Must be able to handle multiple projects simultaneously.
• Comprehensive knowledge of managed care with a specific emphasis on physician credentialing.
• Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment.
• Understanding of credentialing activities as they relate to initial credentialing, re-credentialing, and credentials modification(s).
  
  
  

Professional Competencies

• Integrity and Trust
• Customer Focus
• Proficient in Microsoft Office (Word, Excel, Access)
• Excellent communication (both verbal and written) and organizational skills
  
  
  

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