Managed Care Credentialing Coordinator

Position Summary

Manage, maintain and update files for all credentialing applications. Responsible for processing credentialing and recredentialing applications accurately and in a timely manner. Coordinate with medical office staff, licensing/regulatory agencies, and insurance carriers to ensure Quality Assurance compliance.

Schedule:

• Flexible, may require some evening and weekends

Primary Duties and Responsibilities

• Facilitate initial credentialing, on-going monitoring and re-credentialing process of all Providers in accordance with the National Committee for Quality Assurance standards.
• Maintain and update database for provider credentialing, including applications and all other related documents, such as California Medical license, DEA registration, NPI number, Medical School Diploma.
• Communicates with internal departments to assess addition and removal of providers onto NECC malpractice insurance; process renewal of malpractice insurance on a yearly basis.
• Complete California Participating Physician Application for all new providers and submit to IPA/Health Plans Credentialing Committee for approval; provide IPA/Health Plans with any additional Provider data, as requested.
• Serve as point of contact for IPAs; responsible for advising IPAs of all Provider changes and/or updates, including: demographic changes, clinic assignments, new Providers and release of existing Providers.
• Update IPAs of all Providers' renewed licenses (Medical licenses, DEA registration, etc.).
• Process Hospital Privileges Application for providers, as advised by Operations Director.
• Responsible for completing all Health Plan/IPA and questionnaires.
• Prepare and submit verification letters.
• Provide status reports as requested.
• Handle confidential information in an appropriate manner.
• Attend meetings and seminars, as necessary.
• Maintain a positive working relationship with staff.
• Serves as the Licensing/Certifications Department back up.
• Other duties as designated by Operations Director or Executive Director