Credentialing Coordinator - HPN

About the role

Responsible for timely payer credentialing and/or recredentialing of providers for West Virginia United Health System. This includes, but is not limited to, processing new applications, recredentialing applications, monitoring expiring documents, and monthly monitoring of sanctions.

Responsibilities

• Credentials providers by tracking applications, keying data into the credentialing program, monitoring information requested from providers, and preparing credentials files for review in accordance with NCQA and CMS regulations.
• Performs primary source verification of provider information in compliance with NCQA and CMS standards.
• Maintains working knowledge of NCQA and CMS standards.
• Reviews and analyzes credentialing applications and prepares correspondence requesting additional or missing information.
• Engages in discussions with contacts, both internal and external to HPN, to obtain or relay information concerning network participation, contract activity, and credentialing activity.
• Participates in special projects as assigned by Supervisor.

Qualifications

• High School diploma or equivalent and one (1) year of administrative related experience OR Associates, Bachelors or Masters degree in lieu of experience.
• PREFERRED QUALIFICATIONS: Knowledge of NCQA and CMS regulations regarding provider credentialing.

Skills

• Proficient computer skills including but not limited to thorough knowledge of Windows and Microsoft Office including Excel, or similar applications.
• Excellent organizational and prioritization skills.
• Detailed oriented and excellent grammar skills.
• Professional communication skills.

Benefits

N/A

Pay

N/A

Schedule

N/A

Additional Job Description

Scheduled Weekly Hours: 40
Exempt/Non-Exempt Shift: United States of America (Non-Exempt)
Company: SYSTEM West Virginia University Health System
Cost Center: 649
SYSTEM Managed Care and Payer Relations
Address: 1085 Van Voorhis Rd Morgantown West Virginia
Equal Opportunity Employer: West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws.