Credentialing Coordinator

Primary Purpose: The credentialing coordinator is responsible for organizing, maintaining, and verifying all aspects of the credentialing process for healthcare practitioners based on company Policies and Procedures, and NCQA standards. Principal Duties and Responsibilities (*= essential functions): Maintain policies and procedures to meet NCQA guidelines Retain ownership of Gemini, the CVO used for the credentialing processCreate meeting documents for credentialing and re-credentialing approvalSubmit deliverables for the health plan audits and complete any corrective plans as required Audit Gemini bi-annually to annuallyReview all initial apps for accuracy and completeness Perform credentialing activities for all new physicians for assigned PDT IPAs*Perform re-credentialing activities for all assigned providers due for re-credentialingManage credentialing and re-credentialing for assigned HDOs*Query and review of all the required credentialing data sources, including but not limited to primary source verification, work history, hospital privileges, malpractice claims, OIG, NPDB, Opt Outs, etc Maintain the database to track all current credentialing information and to update expiring information*Prepare credentialing information and reports for Quality Information Committee (QIC), including the reporting of site audits and any adverse provider actions. *Assist with managing current credentialing files for each contracted provider.Assist with managing and successfully pass credentialing audits with all contracted Health Plans.Maintain professional and technical knowledge by participating in ICE credentialing committee meetings.Takes initiative and is innovative in solving or recommending ways to solve issues and communicate to company leadership as applicable. Perform other duties as assigned. Job Specifications:Knowledge of Gemini recommended Minimum of two (2) years credentialing experience required in a Health Plan or IPA environment.Requires the ability to communicate clearly and effectively to peers, superiors, subordinates, physicians and others when representing the company.Ability to multitask, work independently and with minimal supervision.Ability to appropriately maintain confidentiality.Requires fast, accurate typing skills and intermediate level computer software competency, including Microsoft Word, Excel, Outlook, and Knowledge of the following web based queries: NPDB, CAQH, Breeze, OIG, CMS Opt-Out, etc. Position Performance CriteriaProduces accurate and timely work as it relates to departmental goals.Consistent attention to detail, and demonstrates high reliability through punctuality and attendance.Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow through.Uses sound judgment with regard to time management and prioritization of work to balance multiple tasks and meet required timeframes for all administrative activities as required.Demonstrates flexibility and willingness to work with all company departments.Accurately interprets and applies departmental policies and procedures using sound judgment.Communicates clearly, professionally and respectfully to peers, superiors, subordinates and clients.Demonstrates overall professionalism in attitude, demeanor and personal appearancePay Range is $18/HR - $25/HR

Salary : $18 - $25