Credentialing Coordinator

What You Will Do

• Responsible for credentialing behavioral health providers (clinicians and facilities) for inclusion in the Lucet provider network.
• Work collaboratively with providers, external agencies, and other team members within Network Operations and management staff to promote timely processing no matter how complex the credentialing issues.
• Research and verify provider credentials, including licensure, education, insurance coverage, and professional background through phone, email, and fax correspondence.
• Communicate with external agencies and conduct database searches to validate provider qualifications and background status.
• Review provider applications for errors, gaps in employment or insurance coverage, and inconsistencies; follow up to obtain required information and ensure complete submissions.
• Maintain accurate provider records by entering and updating information in credentialing databases, ensuring data integrity and compliance standards.
• Credentialing Operations & Process Improvement:
• Prepare and update provider files for presentation to Credentialing Committee and Clean File Committee meetings.
• Support departmental projects and identify opportunities to improve credentialing workflows, efficiency, and overall process effectiveness.

Required Qualifications

• High school diploma and 2 years health related experience or education.
• Exceptional customer service skills.
• Excellent verbal, written, and oral communication skills.
• Strong computer and Microsoft suite skills specifically Excel.
• Ability to troubleshoot issues and problem solve.
• Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen.

Competencies

• Ability to work well collaboratively; conscientious and positive.
• High detail-orientation and document editing ability.
• Pride of work and accountability.
• Ability to meet deadlines and communicate issues in order to quickly resolve.
• Intuitive nature to identify compliance irregularities.
• Excellent communication and interpersonal skills, with the ability to collaborate across teams.