Credentialing Coordinator

Description

Summary

The Credentialing Coordinator is responsible for ensuring all providers are onboarded/credentialed prior to the indicated start date. The Credentialing Coordinator is required to maintain frequent communication and collaborate with internal and external departments and vendor partners to efficiently credential and re-credential new and existing providers.

Essential Duties and Responsibilities

• Complete and review with accuracy and thoroughness all new provider applications and documentation for credentialing and re-credentialing applications within the outlined timeframe.
• Responsible for communicating with the billing vendor to ensure efficient enrollment/un-enrollment with payors.
• Responsible for communicating with the insurance broker to add/remove providers from the malpractice policy.
• Responsible for communicating with the accounts payable department to submit invoices related to credentialing fees.
• Responsible for updating MS Dynamics and maintaining accurate data and documents.
• Responsible for communicating with providers to obtain required documentation and provide timely follow-up for outstanding items required to complete credentialing.
• Monitors MS Dynamics weekly reports and notifies providers of upcoming expiring licenses and certifications.
• Monitors MS Dynamics dashboard daily to ensure timely credentialing, re-credentialing, and privileges expirations.
• Attend meetings, perform other duties, and report as assigned.

Requirements

To successfully perform this job, an individual must be able to satisfactorily perform each essential duty. The requirements listed below are representative of the knowledge, skill and/or ability required.

• Time management: Ability to organize, plan and prioritize work to complete within required time frames and to follow up on pending issues. Ability to perform multiple tasks simultaneously and thrive in dynamic, fast-paced environments and under pressure.
• Communication: Effective written and oral communication skills to explain complex issues, exchange information between team members, and tactfully discuss quality issues.
• Analytical Thinking: Understand and appropriately apply principles, procedures, regulations, and policies.
• Customer service: Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Flexibility/Adaptability: Is open to change and new information, ideas, methods, or approaches. Work and collaborate effectively in dynamic environments and adjust the original objective or plan to allow for the best possible results.
• Project Management: Organize work, set priorities, and determine short- or long-term goals and strategies to achieve them. Align communication, people, process, and resources to drive success.
• Proficient knowledge using Microsoft Office platforms.

Education/Experience

• High School Diploma or equivalent
• One (1) year of medical credentialing experience and/or hospital privileging experience required.

Physical Requirements

• Standard physical requirements for an office environment to include prolonged periods of sitting and use of hands/fingers.

Direct Reports

• This position does not have direct reports.