Credentialing Coordinator

Description

Job Title

Credentialing Coordinator

Location

Farmers Branch, TX

Position Description

The Credentialing Specialist ensures clinicians successfully pass the client credentialing process. This role is responsible for assisting clinicians with the completion of their credentialing applications, performing primary source verifications, and maintaining the MD Staff credentialing database. The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements. This position reports to the Credentialing Supervisor.

Roles Responsibilities

• Review and process credentialing and re-credentialing files.

• Establish and maintain a system for the timely processing of credentialing files in accordance with NCQA policies.

• Query appropriate organizations and evaluate responses to ensure provider compliance with NCQA standards.

• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.

• Review all background checks, drug tests, and TB screenings and record the results.

• Assemble all verified information and prepare files for presentation to the Credentialing Committee.

• Verify providers' requirements for approval to work in specific states and plans.

• Assist with the ongoing monitoring of contracted clinicians.

• Utilize the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.

• Provide administrative support to department leadership and both internal and external stakeholders.

• Maintain professionalism at all times and provide timely, professional responses to all emails.

• Actively demonstrate teamwork and assist with special projects.

• Responsible for the security and privacy of any protected health information (PHI) accessed during work activities.

Skills

• 1-3 years of successful work experience in a credentialing role/department.

• Intermediate skills with Google Suites.

• Must be familiar with NCQA accreditation standards.

• Obtain NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify.

Education

• High school diploma or up to 1 year of equivalent experience.