Credentialing Coordinator - (Remote in Arizona)

PURPOSE OF THE JOB

The Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers in alignment with State, Federal, and NCQA standards.

Required Qualifications

• 2 years of experience in a healthcare field
• 2 years of experience in provider credentialing
• High-School Diploma or GED in general field of study
• No required licenses or certifications

Preferred Qualifications

• 2 years of experience in a healthcare field, preferably within a credentialing/recredentialing environment
• Knowledge of national accreditation and/or regulatory standards
• Associate's Degree in general field of study
• Certified Provider Credentialing Specialist (CPCS)

Essential Job Functions and Responsibilities

• Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
• Cook up the agenda and document meeting minutes for the Credentialing Committee
• Coordinate with the Credentialing Verification Organization (CVO) and monitor Work in Progress file
• Promptly address incoming files for processing
• Review and maintain all applications for accuracy and completeness
• Accurately and efficiently data enter primary source verification data into the credentialing database
• Input credentialing decisions and dates into the credentialing database
• Generate and mail approval letters to participating providers
• Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain
• Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process
• Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing
• Maintain ongoing participation in cross-training activities
• Provide recommendations and feedback regarding process improvements and/or standardization practices
• Participate in staff meetings, team huddles, and one-on-one meetings
• Engage in team building activities
• Perform all other duties as assigned

Requirements

• Full-time work schedule
• Minimum of 40 hours per week
• Onsite expectation of 0 days per week

Competencies

• Verbal and written communication skills
• Maintains confidentiality according to policy
• Effectively communicates with internal and external customers via telephone and email
• Accurately receives information through oral communication
• Accurately reviews data and figures both in hard copy and electronic formats
• Accurately sorts through data and thinks through issues in a time-pressured environment
• Accurately learns and retains new information, knowledge, and skills
• Efficiently manages multiple tasks, with varying degrees of priority, at the same time
• Ability to think critically
• Strong attention to detail
• Excellent organizational skills
• Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels
• Maintain a calm and collected presence while addressing the concerns from an internal and external customer