Credentialing Coordinator

Responsibilities

The Credentialing Coordinator is responsible for coordinating activities associated with credentialing or re-credentialing therapists for health plans according to plan specifications, in conjunction with the territory operations staff. Included in these activities are researching payer credentialing requirements, the submission of completed payer applications and re-applications, initial mailing, review, and loading into the database tracking system ensuring high quality standards are maintained. Provides feedback to reduce errors and contribute to the development of credentialing policies and procedures.

1. Facilitates the acquisition of applications from payers, evaluating application requirements and forwarding applications and instructions to the territory operations to coordinate completion by therapists.

2. Reviews completed applications to ensure compliance with NCQA and other regulatory and license requirements; assists therapists with application completion and provides guidance where necessary.

3. Maintains database of each health plan's credentialing requirements including ongoing credentialing maintenance requirements, i.e. renewal requirements.

4. Maintains provider database consistent with NCQA standards.

5. Handles correspondence with payer including updates, mailings of applications, and completed executed agreements.

6. Prepares accurate and timely reports for internal staff.

7. Interfaces with senior management, vendors, IS, and operations.

8. Performs other duties as assigned.

Qualifications

1. Bachelor's degree or equal work experience is preferred.
2. Two years plus experience in provider credentialing within the managed care, hospital, or long term care environment.
3. Proficient with Microsoft Office applications and a willingness to learn advanced computer software.
4. Experience with CAQH/NCQA guidelines is preferred.