Duals Credentialing Coordinator I

Mass General Brigham•Somerville, MA

2d•Remote

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. The Credentialing Coordinator I is responsible for the processing, reviewing, and maintaining provider and facility credentialing and re-credentialing files within department turnaround and quality standards. He/she is responsible for working with the management team to monitor compliance of current workflows, assisting with defining revised workflows, and for distributing the day's assignments in the absence of the manager.

Requirements

At least 1-2 years of experience in Clinical/Medical Office/Healthcare required
At least 2-3 years of previous credentialing experience, with at least 1 year in a health insurance environment, highly preferred
Experience with OneCare and/or SCO highly preferred
Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
Competence in Microsoft Office including Outlook, Excel, and Word.
Ability to use independent judgment and to manage and impart confidential information.
Skill in establishing priorities with independent coordination of day-to-day aspects.
Ability to communicate effectively both orally and in writing.
Information research skills.
Ability to handle multiple tasks.

Responsibilities

Enters and updates provider and facility data in credentialing database, PEP, and QNXT while still adhering to input standards, including for the OneCare and SCO lines of business.
Works with External Credentialing Verificaiton Organization (CVO) on processing Credentialing Information and Reporting, as well as Delegate Credentialing information.
Maintains required ongoing monitoring and sanctions reporting.
Coordinates the processing of initial and re-credentialing applications within the established turnaround times while ensuring that Mass General Brigham Health Plan meets all State and NCQA requirements through the HCAS (HealthCare Administrative Solution) streamlined credentialing process.
Conducts verification of credentialing elements completed by CVO (ie. license, DEA, board certification, and NPDB) through the use of system resources, and documents the status in the credentialing database and PEP.
Performs review and analysis of provider and facility credentialing and re-credentialing applications to determine completeness. This would also include notifying providers when their applications are incomplete or missing information.
Provide representation, assistance, and guidance on the credentialing process during committee meetings.
Meets or exceeds all department quality standards for all initial and re-credentialing files.
In the absence of the manager, interacts and responds to inquiries from teammates with specific questions.
Hold self and others accountable to meet commitments.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.