Credentialing coordinator Jobs in USA

Overview

This position will be responsible for the credentialing and re-credentialing of all provider types with Medicare, Medicaid, and other third-party payers, managing the process, and maintaining up-to-date credentialing information. Additionally, this position will work on project work in Regulatory Affairs with some minor administrative duties.

Compensation: $20.00 per hour

Responsibilities

Key Responsibilities

• Maintains high-quality, up-to-date, and accurate credentialing processes for all provider types.
• Assists in the credentialing process by entering/logging/scanning information into Credentialing application for initial, updated, and maintenance processes (license/certification renewals), including verifications.
• Processes and maintains credentialing and re-credentialing in accordance with Joint Commission standards and State and Federal Regulatory regulations.
• Monitors collection of all information received; follows up on missing items and/or incomplete forms, submits follow-up requests for verifications as needed.
• Identifies potential red flags and works in collaboration with the Onboarding Coordinator to document the issue and provider response.
• Maintains all credentialing files, ensuring that all correspondence in the credentialing and recredentialing process is accurately filed.
• Enter and maintain provider information and documents in company’s third-party credentialing vendor’s portal.
• Works with and assists company’s third - party credentialing vendor for accurate and timely completion of payer applications, collection of provider signatures, and tracking of payer credentialing until approvals received.
• Assist with credentialing related to new payer contracting.
• Other duties and responsibilities as assigned.

Qualifications

Required Qualifications

• Must have excellent communication skills: verbal, interpersonal and written. This includes strong spelling and grammar skills and basic mathematical calculations.
• Must have strong ability to self-direct and work independently in a high-volume, deadline-driven role.
• Customer orientation: establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Policies & procedures: articulates knowledge and understanding of organizational policies, procedures, and systems.
• PC Skills: demonstrates proficiency in Microsoft Office (Excel, Access, Word) applications and other as required.
• Outstanding organizational skills and attention to detail.
• Ability to maintain confidentiality of privileged information gained.
• Excellent judgment & prioritization skills proactively prioritize needs and effectively manages resources.

Preferred Qualifications

• Prior medical admistrative experience
• Insurance payer credentialing experience or knowledge
• Knowledge of PECOS, Medicare, NPPES, CMS, NPI Registry