Managed Care Credentialing Coordinator

Duties/Responsibilities

• Aid leadership in developing, planning, implementing, reviewing, and revising managed care credentialing processes, forms, related policies and procedures.
• Maintain a working knowledge of such documents and keep the medical staff updated on all changes.
• Facilitate, coordinate, prepare, monitor, maintain, and implement all credentialing functions for medical staff and advanced practice professionals.
• Ensure all expirables are reviewed, obtained, maintained, and managed by tracking, documenting, and notifying appropriate leadership staff prior to expiration.
• Maintain reporting and communication with hospital leadership regarding credentialing status.
• Monitor payer websites for accuracy and address deficiencies with payers.
• Develop annual goals and objectives for the Managed Care Credentialing function.
• Support the General Counsel in handling legal matters and assist with special projects.
• Provide professional support to management staff and assist with miscellaneous duties and special projects.

Requirements

• High school diploma or equivalent required.
• Associate degree preferred.
• Minimum 2 years of Medical Staff or Managed Care Credentialing Coordinator experience in a hospital, clinic, or health plan setting.
• Certification through the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM, if not already obtained).
• Proficient in computer applications and knowledge of managed care credentialing standards, health plan requirements, and data management.
• Excellent interpersonal communication, organizational, and problem-solving skills.