Credentialing Coordinator

Credentialing Coordinator

The Credentialing Coordinator is responsible for processing and completing the credentialing and recredentialing functions of all providers in accordance with NCQA, state, and federal requirements.

Principal Accountabilities :

• Validates completeness of provider applications prior to processing.
• Conducts primary source verification for all credentialing and recredentialing applications.
• Monitors the progress and completion of all site visits by the provider network team to ensure completion within established timeframe.
• Accurately enters all critical data elements of provider applications into Credentialing system.
• Responds to phone inquiries received into the Credentialing phone queue from internal and external clients.
• Completes projects as assigned.

Requirements :

• 0-4 years of prior provider credentialing experience based on a combination of education and experience.
• High School/GED with 4 years of experience.
• Associate's Degree with 1-2 years of experience.
• Bachelor's Degree with 0-1 years of experience.
• Intermediate knowledge of PC applications, including Microsoft Office.
• Strong verbal and written communication skills.
• Strong organizational skills required.
• Ability to perform in a metrics-driven environment.