Position Summary :

The Credentialing Coordinator reviews applications, prepares verification letters, and contacts clinical staff and insurance carriers to ensure that all active providers have completed applications and credentialing / re-credentialing information on file with the applicable contracted payers.

Essential Duties and Responsibilities :

• Responsible for credentialing, enrolling, and maintaining approximately 300 providers in assigned state / territory; provides support to team members outside of assigned state / territory, as needed
• Obtains all necessary credentialing information and documentation required for payer enrollment process and verifies completed standard applications for assigned providers within 30 days of receiving the onboarding application
• Follows up with payers on outstanding credentialing issues in a timely and consistent manner; resubmits applications in a timely manner as needed
• Communicates all credentialing and payer enrollment approvals to field and internal departments; responds to emails related to payer enrollment within 24-48 hours
• Notifies payers of professional and clinical staff updates such as service locations, periodic roster updates, name changes, official notices, etc., on an ongoing basis
• Audits provider rosters upon payer requests

Qualifications :

• Education : High school diploma or equivalent required
• Work Experience : Minimum 1 year of payer enrollment experience required; 2-3 years’ experience preferred
• Certification / Licensure : Preferred, but not required
• Knowledge and Technical Skills : Knowledge of CAQH / Proview, NPPES / I&A Management System and PECOS preferredKnowledge of Medicare’s enrollment process, including enrollment forms, preferredProficiency in Microsoft 365 requiredWorks effectively both independently and in a team settingAbility to manage multiple responsibilities and tasks based on their importance and urgencyAttention to detail and excellent organizational skills required

Language Skills :

Ability to read, write and speak English proficiently

Physical Demands :

The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e.

while working at a desk), stoop / kneel / crouch, travel around the office, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding.

Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus

Work Environment :

• Consistent with a standard office environment, noise level is low with little to no extraordinary environmental factors.

Last updated : 2024-04-28