Credentialing Coordinator

Our client, a Healthcare company, is looking for a Credentialing Coordinator for their Farmers Branch, TX/ Remote location.


Responsibilities:

• 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
• 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 17and 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..

• 1-3 years of successful work experience in a credentialing role/department.
• Intermediate skills with Google Suites.
• Must be familiar with NCQA accreditation standards.
• Demonstrate active listening skills and the ability to provide and receive constructive feedback
• Strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
• Obtain NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify.
• Working knowledge of problem-solving and decision-making skills.
• Ability to organize and prioritize workload and day-to-day tasks.
• High school diploma or up to 1 year of equivalent experience.

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities