Credentialing Coordinator

Job Description Build and maintain a successful working relationship between Optum Serve and network practitioners to ensure a stable and qualified practitioner network. Facilitate successful activation and maintenance of practitioners by performing initial credentialing, ongoing monitoring, and recredentialing processes of all required network practitioners in accordance with industry standards. Communicate daily with outsourced vendors, healthcare facility points of contact/professionals, as well as with internal staff to maintain a detailed and compliant practitioner credentialing file. As part of the Credentialing Team, ensure the practitioner network meets or exceeds quality, contract, and credentialing expectations to foster continued quality improvement and risk management efforts. Identify and document credentialing, compliance and contract requirements as they enroll in Optum Serve’s network, including the creation and maintenance of practitioner records within databases. Initiate credentialing processes, retrieve, verify/ follow up on all credentialing applications and supporting documentation needed for Optum Serve’s practitioner network. Ensure credentialing applications are complete, data integrity is intact within databases to meet requirements for primary source verification and industry standards. Perform quality reviews on credentialing files throughout each credentialing cycle. Monitor and facilitate complete and accurate re-credentialing of practitioners on a 3-year cycle. Act as the liaison between the practitioner network and internal departments to troubleshoot issues or answer any questions/concerns. Ongoing monitoring of credentialed network for accuracy or any change in status to include regular internal practitioner record audits. Submit appropriate practitioner records to CVO (Certified Verification Organization) or other credentialing vendor, if applicable. Retrieve and review CVO or other credentialing vendor files as completed, if applicable. Schedule and act as facilitator/recorder of credentialing committee meetings on all credential files in need of review. Notify practitioners of decisions. Submit background checks as required on credentialed practitioners to contracted vendor. Retrieve and review the completed background check reports as part of the credentialing packet. Update practitioner statuses as applicable based on the credentialing committee decisions. Preferred Certified Provider Credentialing Specialist (CPCS) through the National Association Medical Staff Services National Career Readiness Certificate Familiarity with NCQA credentialing standards. Knowledge of practitioner credentialing and primary source verification of medical/dental licensure #J-18808-Ljbffr CareerCircle