Senior Credentialing Coordinator

JOB SUMMARY

This position is responsible for providing coaching, operational, and infrastructure support to an operations team responsible for credentialing and recredentialing of practitioners and facilities who are currently contracted or wish to be contracted with the Company. This position will research and consult on standard and escalated practitioner and facility credentialing matters.

DUTIES

Assist Team in daily responsibilities to meet team performance goals to include inventory monitoring and reporting.
2. Manage high priority and specialized requests as appropriate.
3. Reviews, analyzes, and reports on individual, team and department data for trends, gaps, and variances from department performance standards.
4. Ensure all credentialing processes are in compliance with company policies as well as the National Committee for Quality Assurance (NCQA) standards in an effort to maintain accreditation.
5. Provides development and coaching to employees on a consistent basis. Feedback is provided in a timely manner and suggestions for improvements are outlined.
6. Create and maintain internal training materials in collaboration with department management and training teams.
7. Leads training efforts of new team members.
8. Leads mentor, audit, and readiness efforts of new team members and those on a performance improvement plan to identify and model best practice.
9. Assists Department with operational tasks associated with credentialing operations.
10. Participates in projects that involve the collection of credentialing applications.
11. Participates in projects, as a subject matter expert that involve system design/re-design related to credentialing operations.
12. Tests all credentialing operations related system(s) design/re-design related to credentialing operations.
13. Serve as a subject matter expert for all credentialing activities performed within assigned areas including the education and training of staff extenders on credentialing methodologies and approaches, with an emphasis on operational efficiency and quality optimization.
14. Utilizes knowledge outside of team’s standard procedures to increase contextual understanding of processes.
15. Ability to compose and present communications describing tasks and overall context, including existing process guidelines as well as associated risks and controls.
16. Collaborate, coordinate, and communicate across disciplines and departments.
17. Ensure compliance with HIPAA regulations and requirements.
18. Demonstrate Company’s Core Competencies and values held within.
19. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.