Credentials Coordinator

About the role

Process practitioner and organizational provider applications for credentialing based on State and Federal regulations and NCQA accreditation standards.

Responsibilities

• Process practitioner and organization/facility provider applications for credentialing and recredentialing
• Request primary source documentation
• Process documentation requirements
• Verify information received
• Update information in the system of record
• Evaluate overall case categorization and report findings to the Medical Director and Enterprise Credentialing Committee
• Resolve inquiries related to credentialing file disposition
• Provide credentialing status information for group administrators, physicians and their staff, Provider Services, Customer Service and Network Development
• Attend Credentials Committee meetings (when designated by leader) and conduct internal meetings
• Participate in auditing processes
• Assist with special projects and job aids as needed

Qualifications

• Associate degree preferred
• Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital business office role and/or credentialing related field required
• Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing required
• Knowledge of CAQH required
• Excellent organizational skills with attention to detail required
• Excellent verbal and written communication skills required
• Ability to handle and prioritize multiple case files and timelines required
• Ability to work effectively independently or in a team environment required
• Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use required
• Excellent interpersonal skills and the ability to interact with internal/external customers