The Provider Credentialing Coordinator is responsible for the background checks, applications and document follow-up.
GENERAL DUTIES AND RESPONSIBILITIES:
- Maintains knowledge of current requirements for credentialing providers.
- Prepare and/or update the provider’s application for newly affiliated and existing providers.
- Processes applications for appointment and reappointment for One Call.
- Build knowledge base for payer requirements and forms.
- Tracks license, and professional liability expirations for appointed providers.
- Completes provider credentialing and re-credentialing applications for escalated cases; monitors applications and follows-up as needed.
- Ensures recredentialing timeliness meets and/or exceeds the NCQA expectations by following up in a timely manner and escalating items as designated by policy.
- Maintains appointment files and information in credentialing.
- Provides excellence in customer service for internal and external customers when handling communications, whether oral or written.
- Ensure all workflow items are completed within the set turn-around-time, meeting expectations.
- Responsible for exceptions in committee decision follow up.
EDUCATION REQUIREMENTS:
- Associate’s degree or other related discipline is preferred; or equivalent combination of education and experience that is required for the specific job level.
GENERAL KNOWLEDGE, SKILLS AND ABILITIES:
- Excellent attention to details.
- Ability to work independently, set priorities and meet deadlines with minimal supervision.
- Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products.
- Ability to communicate effectively, both orally and in writing.
- Must be able to communicate well with a wide variety of contacts at all levels of the organization.
- Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization.
- Ability to maintain confidentiality, work with deadlines and manage multiple priorities.
- Ability to maintain a high degree of professionalism and independent judgment in response to complex sensitive issues and decision-making.
- General understanding of related accreditation and certification requirements.
- General understanding of medical credentialing and privileging procedures and standards.
- General understanding of medical staff policies, regulations, and bylaws and the legal environment within which they operate.