Credentialing Coordinator 100% REMOTE LOCAL ONLY Mon-Fri 8am-5pm Required
High School Diploma or GED required AND 3 years medical staff credentialing experience in a healthcare or insurance provider setting; OR Associates Degree and 3 years’ experience performing data collection or data analysis using complex database software systems Required competencies: Demonstrated software database experience (for efficient generation of letters and other correspondence, activity tracking and report production).
Familiarity with legal, state, TJC and NCQA guidelines in assuring medical staff compliance with regulatory agencies. Certified Provider Credentialing Specialist (CPCS) preferred
Assumes responsibility for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care. Ensures providers are credentialed, appointed, and privileged with delegating health plans. Maintains up-to-date data for each provider in credentialing database and online systems; ensure timely renewal of licenses and certifications.
Works on routine assignments within defined parameters, established guidelines and precedents.
1. Reviews provider credentialing and re-credentialing applications; monitors applications and follows-up as needed. 2. Compiles and maintains current and accurate data for all providers.
Audits health plan directories for current and accurate provider information and assists with payer audits 3. Maintains copies of current state licenses, Drug Enforcement Agency (DEA) certificates, malpractice coverage and any other required credentialing documents for all providers. 4. Sets up and maintains provider information in online credentialing databases and system. 5.
Tracks license and certification expirations for all providers to ensure timely renewals. Tracks license, Drug Enforcement Agency (DEA) and professional liability expirations for providers.