Provider Enrollment Coordinator II (Credentialing experience required)

Job Summary :

The Provider Enrollment Coordinator II is responsible for ensuring that credentialing activities comply with URAC, NCQA, state and federal regulations.

Essential Functions :

• Ensure credentialing activities comply with URAC, NCQA, state and federal regulations
• Check daily work queues to determine priority of workload including routine credentialing processing and maintenance
• Perform review functions on files prior to initiating Primary Source Verification (PSV) and Secondary Source Verification (SSV) including, but not limited to discontinuations, provider notifications, and other credentialing functions
• Coordinate efforts with Provider Relations (PR), Provider Data Integrity and provider to complete / obtain all missing components of each application
• Complete PSV and SSV for providers and organizations
• Utilize critical thinking skills when reviewing provider files to determine if provider meets established criteria
• Submit completed applications for auditing prior to Credentialing Committee
• Responsible for staying abreast of : state and federal regulations pertaining to provider credentialing and re-credentialing, CareSource Credentialing Policies and Procedures and Standard Operating Procedures to ensure that all credentialing and maintenance of providers are managed to expectations, and NCQA and URAC Credentialing Standards to ensure compliance and continued accreditation
• Perform monthly mailings for providers due for re-credentialing
• Complete provider re-credentialing within required time-frame
• Respond to calls and emails from internal / external customers, Monday-Friday, 8am-5pm
• Scan credentialing files and attach in Cactus in a timely manner
• Assist customers while on the Credentialing phone queue
• Adhere to Credentialing Service Level Agreements
• Identify and prepare provider issue files to present to Medical Director for review, decision and signature prior to Credentialing Committee presentation
• Prepare and reconcile weekly Credentialing Committee Roster and present to Medical Director for review, approval and signature
• Process approved weekly Credentialing Committee files utilizing Cactus to generate roster, close records, create appointment letters and update status codes
• Work on special projects as assigned that include reconciliation projects, processing urgent provider and organization applications, and others
• Maintain confidentiality of provider information and ensure all provider files are securely stored in the credentialing file drawer or in the provider file room at close of business each day
• Perform any other job duties as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$40,400.00 - $64,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Hourly

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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