Credentialing Coordinator

TITLE: Credentialing Coordinator


LOCATION: in office in Jericho, NY


PAY : $58,000-62,000


SCHEDULE: Monday-Friday 8:30am-5pm EST (some flexibility to meet providers as needed required)


TARGET CANDIDATE BACKGROUND : Looking for someone with 1-2 years of healthcare administrative experience. Someone with a customer service and physician admin background ideally. Must be able to work in a number of different systems and be professional to talk on the phone or over email with providers to bring them through the process. Must be a self starter that is able to problem solve to meet the tight deadlines with the level of details needed for the Panel onboarding. Experience working with federal systems and onboarding is a big plus.


GENERAL RESPONSIBILITIES:


This individual will be responsible for all activities associated with onboarding and credentialing of Clinical Reviewers, specifically for U.S. Department of Veterans Affairs, Veterans Health Administration (VHA) Peer Review Contract. Duties include but are not limited to the processing of provider applications and re-applications; reviewing and loading information into the database tracking system to ensure high quality standards are maintained and compliant with all regulatory and organizational standards.


DUTIES AND KEY RESPONSIBILITIES :


1. Application Management: Prepare, submit, and track initial and re-credentialing applications for all Clinical Reviewers, including the VHA Federal PIV (personal identification verification) card. Send application to the credentialing verification organization (CVO) for credentialing, liaise with IPRO's credentialing coordinator and follow-up on the process as necessary.


2. Database Maintenance: Manage provider records in online platforms for internal and external credentialing systems. Optimize efficiency and performs query, reports and document generation.


3. Compliance & Auditing: Ensure all provider files remain compliant with URAC and state/federal regulatory guidelines and all contract requirements.


4. Expiration Tracking: Monitor the expiration dates of critical documents (e.g., state licenses, CPR certifications, liability insurance) and facilitate the timely renewal process.


5. Communication: Act as the primary liaison between Clinical Reviewers, internal departments and Medical Directors to resolve discrepancies and expedite the onboarding process. Be available at short notice to assist reviewers with applications, instructions, appointments and PIV access facilitation. Work closely with other departments regarding credentialing audits, internal files, running reports and identifying additional clinicians for credentialing Clinical Reviewers at their request.


6. Meeting Management: conduct ongoing Credentialing Committee meetings with internal, external departments and clinical team members, including Medical Directors. Assist with all Recruitment and Onboarding activities as needed.


7. Assist with all Recruitment, Onboarding and other departmental activities as assigned.


QUALIFICATIONS :


1. Excellent communication skills (verbal and written), exceptional attention to detail.


2. Excellent interpersonal skills with the ability to successfully interact with all levels of internal and external customers.


3. Strong organizational and time-management skills with the ability to prioritize work and manage multiple tasks.


4. Ability to maintain a positive, professional demeanor at all times.


5. The ability to work with minimal supervision as well as part of a team.


6. Strong computer skills with proficiency in MS Office (Word, Excel, Access & PowerPoint).


7. Database management skills, including querying and document generation.


8. Attention to detail to assure accuracy of reports and data required.


9. Understanding of healthcare, credentialing, and the need for safeguarding confidential information.


EDUCATION & EXPERIENCE :


1. Bachelor's degree in healthcare administration, business, or related field, preferred.


2. A minimum of three (3) years of work experience in a healthcare setting with multiple project responsibilities.


3. Prior credentialing experience, especially with government organizations, required.


* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.