Credentialing Coordinator / Job Req 721743116

About the role

The Credentialing Coordinator works under the supervision of the Supervisor, Peer Review and Credentialing and assists in all aspects of the Credentialing department functions. The Credentialing Coordinator is responsible for coordinating, monitoring, and maintaining the credentialing and recredentialing processes of health care providers and practitioners to ensure they meet the requirements of the Alliance credentialing policies and regulatory agencies.

Responsibilities

• Prepare initial Credentialing application requests for Chief Medical Officer or Medical Director review.
• Send and track Credentialing application requests.
• Evaluate Credentialing applications for completeness and compliance.
• Coordinate initial and recredentialing file processing with Credentialing Verification Organization (CVO).
• Audit files, obtain credentialing documents or additional information as required.
• Track and follow up on all credentialing/recredentialing documentation as necessary.
• Contact practitioners to clarify discrepancies.
• Ensure Credentialing application timeliness per NCQA requirements.
• Perform data entry and maintain accuracy and integrity of the credentialing database system.
• Produce credentialing reports as required for Alliance departments, CVO, and special requests.
• Review expirable reports and notify Supervisor, Peer Review and Credentialing of potential issues.
• Provide administrative support for Peer Review Committee (PRC) and the Credentialing Committee (CC) meetings.
• Monitor on-going state, federal, and licensing agencies to identify potential provider sanctions on a monthly basis.
• Ensure credentialing compliance standards are met per accrediting and regulatory agencies.
• Assist Supervisor, Peer Review & Credentialing with delegated or internal credentialing audits, HEDIS, and other projects as assigned.

Requirements

• Must be a California resident as of their first day of employment.
• Bachelor’s degree or equivalent experience.
• NAMSS Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Staff Management (CPMSM) certification preferred.
• One to three years experience within a health care/managed care environment required.
• Knowledge of commonly used concepts, practices, and procedures used in health care credentialing.
• Minimum two years previous credentialing experience preferred.

Skills

• Working knowledge of Medical Staff principles and operations specific to regulatory expectations.
• Sound knowledge and understanding of Credentialing Committee and Peer Review Committee processes.
• Experience with Symplr (formerly CACTUS) Software or similar credentialing system.
• Possess excellent interpersonal, writing, and communication skills.
• Possess excellent organizational skills and attention to detail.
• Able to maintain strict adherence to deadlines.
• Able to meet productivity and quality goals.
• Able to build successful internal and external customer relations.
• Able to function well within a team environment and independently.
• Able to maintain confidentiality.
• Possess intermediate Microsoft Office skills in Microsoft Word, Excel, Outlook, and PowerPoint.

Pay

The salary range for this position is $27.11 - $40.66 hourly.