Coordinator II - Credentialing Coordinator

Job Title : Coordinator II - Credentialing Coordinator

Location : Remote position based in RI

Pay Rate : $21.00 / hr on W2

Duration : 5 Months + Possible Extension

THESE ROLES ARE REMOTE

The Credentialing Coordinator is responsible for initial credentialing and re-credentialing nurse practitioners, physician assistants and physicians in a compliant and timely manner;

monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.

• Responsible for the timely and accurate processing of all providers including NP’s / PA’s / MD’s initial and Re-credentialing applications according to the client's Provider Credentialing Program
• Monitor Expired licensure reporting , data base tasks and maintain system updates and weekly reporting to leadership
• Manage Epic access for any providers that have out of compliance licensure and / or board certification.
• Conduct sanctions and compliance monitoring and alert Credentialing Manager and Revenue Director of any undisclosed negative findings
• Process malpractice insurance verification requests according to internal policies
• Maintain the provider and physician SharePoint sites and Communicate provider status’s with leadership and other internal teams to meet timelines
• Submit system access requests upon credentialing approvals / clinic eligibility
• Support the payer enrollment team as needed to resolve any payer claim issues
• Monitor Provider and Clinic change / Termination reports and update data base accordingly
• Process Name changes according to client's policies and procedures
• Daily maintenance of provider credentialing grids with notification to appropriate teams
• Review and distribute all incoming mail as needed
• Support Payer Audits in accordance with client's, Joint Commission and NCQA requirements
• Maintain provider files with the most current information / documentation
• Notify system analyst and leadership of any system and state agencies interruptions / updates / password changes
• Make recommendations for process improvement and system efficiencies
• Attend and engage in all team meetings
• Model a positive attitude in interactions with team members

Required Qualifications :

• Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expireables management.
• Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
• Ability to function independently and utilize critical thinking skills to accomplish goals and objectives
• Effective communication skills; verbal and written
• Strong interpersonal skills including the ability to work well with internal and external stakeholders
• Strong organizational skills and the ability to multitask
• Competent user of Microsoft Office, Outlook, Word, and Excel
• A minimum of 3 years experience in the healthcare industry with experience in credentialing

Preferred Qualifications :

• NAMSS Certified Professional Credentialing Specialist (CPCS) certification
• Education - Verifiable High School Diploma is required

Position Summary :

The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities.

Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention.

The Enrollment Coordinator II reports directly to the Enrollment Supervisor.

Duties :

Develop fixture and merchandise layouts that accurately reflect required product mix based on store location and clientele.

Includes identifying stores within a growing number of cluster definitions (i.e., ethnicity, affluence, geography, etc.) that ultimately drive automated product replenishment.

Independently prioritize and manage scheduled assignments to insure on-time project completion. Analyze, prioritize and summarize data, and compare to company standards in such a way that identifies opportunities on a store specific basis.

Interact with Regional Sales Manager to confirm store specific analysis (e.g., sales, competition, ethnicity of clientele, etc.

in an effort to maximize individual store profit; and to confirm product mix, category adjacency and service issues as they relate to customer needs.

Support corporate expense control by managing the impact of layout changes relative to established budget guidelines. Advocate alternative approaches, as needed, and communicate incremental scope of work and added cost to field management and project partners.

Work with the Construction team and outside vendor architects to develop innovative merchandising solutions for atypical store locations.

Experience :

At least 1 years of overall related experience of Center for Medicare / Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes or previous work experience in regulatory environment Dependable / Responsible / Accountable Excellent spoken and written communication skills Capable of managing through transition, while fostering a positive team environment Confident in decision making ability within strict timelines Exceptional prioritization and organizational skills Acts with integrity and uses sound judgment in dealing with confidential information

Education :

Verifiable High School diploma or GED required; Bachelors Degree in Marketing preferred