POSITION PURPOSE:
The Credentialing Coordinator is responsible for the coordination and implementation of all aspects of the credentialing, re-credentialing, privileging, and enrollment processes for providers and licensed staff as indicated in the Credentialing and Privileging policy.
MAJOR POSITION RESPONSIBILITIES AND FUNCTIONS:
- Review practitioners' applications and supporting documents for completeness and to ascertain their eligibility for initial and renewal of privileges. Liaise with applicants to ensure that all applications are completed and processed appropriately.
- Identify discrepancies in information on initial and recredentialing applications and conduct follow-ups on a timely basis.
- Initiate verification of all information contained therein as well as ensuring that request for privileges are appropriate based on set criteria.
- Initiate electronic verification of licensure and other certifications. As necessary, conduct manual verification of credentials (previous work verifications, claims history, peer
references, etc.) for institutions not currently using online verifications.
- Ensure in-house initial credentialing and recredentialing processes is completed within the required timeframe.
- Ensure initial credentialing documentation is received by IPAs, health plans, including behavioral health plans within the required timeframe.
- Ensure health plan and IPA recredentialing processes are completed within the required timeframe.
- Submit initial provider applications/enrollments to various payor programs (PAVE, PECOS) within the required timeframe.
- Complete initial enrollment or review, and maintenance of provider CAQH profiles for health plan credentialing.
- Complete health plan and IPA re-credentialing requests.
- Respond to all IPA and health plan provider inquiries.
- Monitor upcoming dates for recredentialing applications; initiate process within required timeframe prior to due date.
- Monitor upcoming expiration of provider documents/certifications withing required timeframe; assist providers as needed to obtain updated information.
- Maintain confidentiality of all provider information within credentialing database, as well as all documentation gathered throughout the credentialing process.
- Maintains accurate, up-to-date files and rosters on all clinical providers for EVCHC.
- Participate in administrative staff meetings and attends other meetings, and seminars.
POSITION REQUIREMENTS AND QUALIFICATIONS:
- High school diploma, GED, or suitable equivalent.
- 2+ years of credentialing experience with hospital or community health center medical staff.
- Basic knowledge of medical credentialing and privileging procedures and standards.
- Knowledge of provider enrollment procedures for PAVE, PECOS, CAQH.
- Strong written and verbal communication skills.
- A high level of detail orientation and multi-tasking ability.
- Excellent customer service skills.
- Proficient with Microsoft Office products (Word, Excel, Outlook, SharePoint).
- Problem solving/analysis with an understanding of common credentialing practices and knowledge.
- Project management ability from conception to execution and delivery on timeline.
WORKING CONDITIONS/PHYSICAL/MENTAL ABILITIES AND PROCESS:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
- Work requires periods of standing, sitting, lifting, turning, twisting, walking, pushing, pulling, reaching, speaking, hearing, seeing and ability to articulate clearly, use of hands to finger, reaching with hands and arms.
- Ability to write notes, track records and reports.
DOE: $27.00 - $31.88
East Valley offers a competitive salary, and excellent benefits including medical, dental, vision, and defined contribution retirement plan. You will also enjoy a work-life balance with paid time off and paid holidays throughout the year.
Please apply to this position with your current resume.
Principals only. Recruiters, please do not contact this job posting.
EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities, and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.