Credentialing Coordinator

Role & responsibilities

• Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements and company credentialing policies.
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
• Prepare and scan credentialing/re-credentialing files and other credentialing documentation into scanning software.
• Data entry of new applications in the credentialing database.
• Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing.
• Answer credentialing telephone line and provide support to physicians, physician office staff, health plan contacts and company departments as necessary.
• Cross train within department to support credentialing operations (providing back-up support for telephones, credentialing files, vacation/PTO).
• Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
• Maintain CAQH (Council for Affordable Quality Healthcare) database and application process.
• Maintain the credentialing database and ensure up-to-date information is always obtained.

Preferred candidate profile

• Must be able to operate a general computer, fax, copier, scanner and telephone.
• Must demonstrate exceptional communication skills, listening effectively and asking questions when clarification is needed.
• Ability to follow instructions and respond to Managements directions accurately.
• Demonstrates accuracy, organizational and problem-solving skills. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Maintain confidentiality.
• Work independently, prioritize work activities and use time efficiently.
• Must demonstrate and promote a positive team-oriented environment. Must be able to stay focused and concentrate under normal or heavy distractions.
• Must possess ability to manage change, delays, or unexpected events appropriately
• Minimum 3 Years or Experience in US Healthcare.
• Experience with CAQH (Council for Affordable Quality Healthcare) database and application process.