Under the supervision of the RCM, the Credentialing Coordinator is responsible for initiating, processing, and completing the credentialing and re-credentialing functions for medical group and practitioners. The Credentialing Coordinator is responsible for Primary Source Verification. The Credentialing Coordinator responsibilities include maintaining knowledge of local, state and federal regulations, maintaining productivity and accuracy standards associated with the credentialing functions.
Process provider applications in an accurate timely manner. Review applications for completeness of the application and supporting credentials, including current status of all time-sensitive information.
Performs Primary Source Verification.
Documents the date of receipt of applications and supporting documents. Scans all original documents and completed applications into individual provider files.
Enter data of all initial credentialing and re-credentialing application into the master credentialing database.
Request and obtain all missing information and/or updated information related to the application or source documents.
Establish a credentialing file for all new providers.
Obtain primary source verification of licensure, education and training, and specialty board certification
Query online databases for malpractice and sanction reports.
Communicate timeline of all provider credentialing clearly and effectively to the senior management team.
Provide accurate and timely response to inquiries regarding provider status as it relates to the credentialing and re-credentialing process.
Manages and reports reconciliation for outstanding providers, identification of provider requiring credentialing, and education to the credentialing and re-credentialing process.
Adhere to established company guidelines.
Job Related Requirements Qualifications/Knowledge/Skills/Abilities
Required 3-5 years proven Credentialing experience
Required proficiency with Microsoft Office applications (Excel, Word).
Required effective verbal and written communication skills.
Required ability to plan own schedule, set priorities and work.
Required CPCS certification or equivalent professional work experience.
Required computer proficiency
Preferred knowledge of basic Health Care, Managed Care principles, and Medical terminology.
Must work in the office as this is not a remote/telecommuter role.