Credentialing Coordinator - BioPlus Specialty Pharmacy

Credentialing Coordinator

Primary Location(s): Lake Mary, FL

Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. 

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Credentialing Coordinator coordinates and leads credentialing program-level compliance activities for the sanction monitoring program, delegation oversight audits and/or regulatory and compliance audits.

How You Will Make an Impact:

• Performs oversight of credentialing and re-credentialing activities and processes, including internal and external audits.

• Responsible for account management of contracted organizations.

• Acts as a liaison to delegates and credentialing vendors to ensure that credentialing program compliance requirements are maintained.

• Monitor contract compliance and coordinates/negotiates contractual language changes when required.

• Coordinates all compliance filings of credentialing specific documents and policies.

• Coordinates and conducts initial, annual and focused (corrective action plan) audits, including vendor and/or delegation oversight, or department audits.

• Provides feedback and recommendations to improve processes and performance.

• Resolves issues independently specific to delegation oversight, sanction monitoring, validation, notification, system configuration and reporting, and credentialing policy and procedural reviews and exceptions.

• Serves as corporate contact and interface with internal business partners on problems, resolutions, questions, and regulatory or accreditation audits.

• Provides process oversight of daily business operations as it relates to resolution of non-responsive providers to credentialing and re-credentialing.

• Maintains delegation/credentialing standards and business requirements.

• Researches and resolves delegated credentialing-related issues.

• Provides recommendations to committee on process administration.

• Reviews assigned Health Plan elements in Credentialing Manual and provides updates as appropriate regarding new or improved documentation resources and business rules.

• Leads special projects

Minimum Requirements:

Requires a BA/BS degree in a related field and minimum 5 years credentialing experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

Strongly preferred credentialing certification.

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