Credentialing Coordinator Job Description Template
Our company is looking for a Credentialing Coordinator to join our team.
Responsibilities:
- Verify professional licensures to meet the requirements of our delegated insurance contracts;
- Completes background checks, licensure verifications and education verifications for clinician as required;
- Obtains and conveys information to applicants and clients as appropriate;
- Assist supported offices and administration with Explanation of Benefits, Claims, and other insurance related issues;
- Complete insurance applications and contracts for over 1500 supported dentists;
- Communicate with insurance administrators to maintain up to date files on supported dentists;
- Works with clinicians to obtain required new hire paperwork and credentialing documentation to ensure on-time start of their assignment;
- Ensure accuracy of files by tracking the expiration of licenses and certifications;
- Maintain up-to-date knowledge and understanding different insurance plans and Medicaid;
- Conducts job duties in accordance with the Corporate Values and Culture;
- Represent Credentialing Department at internal cross-functional meetings;
- Use and maintain PCPA’s comprehensive Credentialing Program, including a comprehensive work plan of credentialing activities;
- Assist in the execution of PCPA policy and procedure for the management of provider corrective action plans;
- Represent PCPA at external meetings as needed;
- Monitor the state of provider credentials and accreditation in this database, anticipating the need for any renewals, updates, and recredentialing.
Requirements:
- Good organizational skills;
- Excellent interpersonal skills and commitment to quality improvement;
- Strong analytical skills, including process improvement and problem resolution;
- Healthcare Staffing Industry experience strongly preferred;
- Strong organizational skills;
- Demonstrated working ability in a health care setting desired;
- Demonstrate sense of urgency;
- Knowledge of credentialing and health insurance systems preferred;
- Bachelor’s degree;
- Prior experience in a healthcare setting, provider organization, or with health policy is preferred;
- Ability to influence others and gain alignment on issues of significant importance to the company;
- Ability to function effectively and work under pressure in a demanding and fast paced environment;
- Excellent organizational, problem solving and critical thinking skills;
- Strong attention to detail and critical thinking/analysis skills required;
- Excellent customer service skills.