Overview
Under the direction of Member Processing & Credentialing Manager, the Payor Credentialing Coordinator performs provider credentialing and re-credentialing services in compliance with Choice Health policies and procedures, the guidelines of the National Committee for Quality Assurance (NCQA), the legal requirements of the NC Department of Insurance, as well as all other applicable State and Federal Laws.
Performs provider credentialing and re-credentialing services in compliance with Choice Health policies and procedures, the guidelines of the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), the legal requirements of the NC, SC, & VA Department of Insurance, as well as all other applicable State and Federal Laws.
Responsible for creating and maintaining provider credentialing files, performing primary source verification on all credentials, and querying the National Practitioners Data Bank for all Choice Health and NHMG providers.
Prepares for and participates in Choice Health Credentialing Committee meetings. Prepares and maintains Credentialing committee minutes.
Acts as liaison with the Choice Health Medical Director on all Credentialing related issues. Assists Choice Health Director of Operations and Member Processing & Credentialing Manager with the development and implementation of Credentialing policies and procedures.
Ensures maintenance of Choice Health physician credentials with contracted managed care organizations and insurance companies.
Provides support to physicians and practice manager in the application and credentialing process and acts as liaison with managed care organizations, self-insured businesses, insurance companies and Choice Health members.
Promotes improvements in the medical management of chronic diseases, and preventive services to Choice Health providers.
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Therefore, we invite applicants from all group dynamics to
Payor Credentialing Coordinator
Under the direction of Member Processing & Credentialing Manager, the Payor Credentialing Coordinator performs provider credentialing and re-credentialing services in compliance with Choice Health policies and procedures, the guidelines of the National Committee for Quality Assurance (NCQA), the leg...
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