GENERAL SUMMARY OF DUTIES: Credentialing Coordinator who will be responsible for credentialing and re-credentialing providers with insurance companies, state and federal payors, and other third-party payors. While working collaboratively with other internal departments, the Credentialing Coordinator will also establish and maintain positive relationships with payors. High organizational skills, attention to detail, and highly effective and professional communication is required for this role
Job Title: Credentialing Coordinator
Reports To: CEO
FULL TIME NON-EXEMPT
JOB Description PDF
- Review all onboarding documentation for new hires to ensure it meets payor/state guidelines and requirements for credentialing.
- Partner with onboarding to identify any barriers to credentialing new providers
- Submit all verifications, credentialing applications, and other documentation within organization guidelines for newly onboarded providers • Credential practice locations and advanced imaging units
- Maintain accurate and complete credentialing files for providers in appropriate storage systems and platforms
- Effectively and professionally communicate status updates as requested to internal partners regarding credentialing of providers
- Provide clear timelines and requests for updated information for re-credentialing to providers as appropriate
- Build, improve, and maintain positive working relationship with payors through frequent communication and follow up on provider credentialing
- Complete payor updates and maintain payor directories
- Under direct supervision learns the credentialing and verification process
- Conduct verification of credentialing elements using system resources and approved departmental tools and document status within credentialing database(s)
- Files all information promptly
- Works with physicians to complete and obtain documentation
- Ability to compile and maintain current and accurate data for all providers
- Ability to complete provider credentialing and re-credentialing applications in coordination with third party credentialing resource
- Ability to maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
- Tracks license, DEA and professional liability expirations, Nurse protocols and certifications for providers
- Assist providers with tasks associated with licensure
- Knowledge of current managed care plans and government requirements for credentialing providers
- Assist Billing Department with claim issues related to provider participation
EXPERIENCE: Minimum 2 years credentialing experience preferred
- Knowledge of organization policies and procedures.
- Knowledge of fiscal management and human resource management practices
- Knowledge of computer systems, programs, and application
- Knowledge of health care administration principles.
- Knowledge of HIPAA and Security regulations
- Knowledge of Medical Malpractice matters
ENVIRONMENTAL/WORKING CONDITIONS: Work is performed in an office and/or clinical environment. Position involves frequent contact with staff and patients. Work may be stressful at times. Contact may involve dealing with angry or upset people. This position does require some travel.
PHYSICIAL/MENTAL DEMANDS: Work requires hand dexterity, stooping, bending, mobility to complete errands and sitting. Employee must possess visual and auditory acuity in order to communicate with physicians, co-workers, patients and other customer groups. There is possible exposure to communicable diseases and body fluids. Employee must be able to lift up to 25 lbs.