Credentialing Coordinator

Credentialing Coordinator

POSITION SUMMARY: The Credentialing Coordinator role will be responsible for ensuring compliance with NCQA, URAC, Medicare, Medicaid, Delegation agreements and other pertinent client requirements, policies and procedures, client health plan contracts, URAC guidelines and applicable state and federal requirements. Responsibilities may include: verifying state licenses, exclusions lists, DEA's, board certifications and Medicaid/Medicare enrollment verifications on an ongoing basis to ensure qualified and approved clinicians remain active in the network. Enrolling clinicians in Medicare and Medicaid following state and federal guidelines applying for state licensure for clinicians. S/He will maintain strong cross-departmental relationships with Recruiting, Production, and Education. This role will report to our Supervisor of the Credentialing Hub. Candidates will monitor files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate. Enters, updates, and maintains data from provider applications into the credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses and in accordance with internal policies and procedures. Prepares, issues, electronically tracks, and follows up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines. Communicates clearly with providers, internal/external clients, and all Signify Health staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest developments to enhance understanding of various regulations and legislation of the healthcare industry and assist with special projects on an as-needed basis.

QUALIFICATIONS: Preferred NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS). Preferred CAQH Experience, preferred MD Staff Experience, preferred Goggle Suites Experience and highly preferred Licensure Experience.