Credentialing Coordinator

Overview

This position will be responsible for the credentialing and re-credentialing of all provider types with Medicare, Medicaid, and other third-party payers, managing the process, and maintaining up-to-date credentialing information. Additionally, this position will work on project work in Regulatory Affairs with some minor administrative duties.

Responsibilities

• Maintains high-quality, up-to-date, and accurate credentialing processes for all provider types.
• Assists in the credentialing process by entering / logging / scanning information into Credentialing application for initial, updated, and maintenance processes (license / certification renewals), including verifications.
• Processes and maintains credentialing and re-credentialing in accordance with Joint Commission standards and State and Federal Regulatory regulations.
• Monitors collection of all information received; follows up on missing items and / or incomplete forms, submits follow-up requests for verifications as needed.
• Identifies potential red flags and works in collaboration with provider to document the issue and provider response.
• Advises Supervisor of any questionable information received, and any issues identified during the processes.
• Maintains all credentialing files, ensuring that all correspondence in the credentialing and recredentialing process is accurately filed.
• Enter and maintain provider information and documents in company's third-party credentialing vendor's portal.
• Works with and assists company's third - party credentialing vendor for accurate and timely completion of payer applications, collection of provider signatures, and tracking of payer credentialing until approvals received.
• Assist with credentialing related to new payer contracting.
• Other duties and responsibilities as assigned.

Qualifications

Seniority level

Employment type

Job function

Industries

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