Credentialing Coordinator

Community Care Network Of Va

7h•Remote

About The Position

At Cenevia, we eliminate operational burdens so our healthcare delivery champions can focus on providing high-quality and cost-effective health outcomes. Since 1996, Cenevia has been a trusted support system, training partner and business process expert for health providers, including Federally Qualified Health Centers (FQHC), private practices, hospitals, managed care organizations, and provider networks. Cenevia provides integrated, network-based services and programs to healthcare clients to help them run their businesses better so that they can focus on patient care. This includes the centralized practice management system, help desk, and support infrastructure that Cenevia established in 1999. The Cenevia staff includes experienced health care professionals from the following areas: Quality Improvement Health Information Technology Revenue Cycle Management Health Plan Contracting Credentialing and Enrollment (NCQA-certified) Summary/Objective: This non-exempt position performs administrative duties requiring accuracy and attention to detail in the credentialing/recredentialing process. Maintains continuous contact with internal and external customers, including practitioners, administrators and support staff. Additionally, this position is responsible for communicating provider information to stated internal and external customers through established processes for credentialing/recredentialing. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Requirements

High School diploma or GED required
Able to work with minimal supervision and ability to work well in both individual and group environment
Experience with Microsoft Word Office Suite

Nice To Haves

Preferred one (1) year experience in healthcare credentialing (i.e., healthcare facility, credentials verification organization, or Medical Staff Office)
Preferred working knowledge of the health care and credentialing industry, regulatory agencies, and other national standards

Responsibilities

Serve as subject matter expert in Credentialing activities for department.
Assist departmental leadership with day-to-day departmental administration and operations
Assist leadership with departmental reporting and metrics towards efficient processes and deliverables
Serve as liaison with other departments as point of contact on Credentialing and Enrollment matters and initiatives
Responsible for creation and maintenance of departmental new hire training and cross training program development
Responsible for new employee departmental onboarding and integration to increase optimal performance outcomes
Responsible for Credentialing Committee meetings and drafting minutes if needed
Prepares files and supporting data for Credentials Committee meeting
Participation in departmental strategic planning efforts and related meetings
Manual Entry of Practitioner information into the credentialing database in a timely manner
Ability to read, extract and interpret information comparing such to established departmental policies. Maintains a computerized database of practitioner data for use in the credentialing & enrollment process
Excellent verbal and written communication skills
Self-motivated with the ability to complete projects independently within established timelines
Ensure workload deadlines are being met in a consistent manner
Must be flexible and willing to work extra hours during peak workloads and deadlines
Ability to problem solve, make decisions and effectively communicate
Ability to work productively within a team
Prepares and provides reports, recredentialing applications, status reports, expired items reports and completed file reports to assure time frames are met and filing and scanning when necessary
Accurately perform a variety of administrative duties such as: placing calls, processing facsimile verifications, scanning, sending written inquires, filing and copying.
Ensures consistent & complete verification of practitioners credentialing/recredentialing
Maintains a computerized database of practitioner data for use in the credentialing/recredentialing
Generates verification letters, and upon receipt of verification letters, logs the appropriate response in the Credentialing database
Maintains detailed credentialing/recredentialing files in electronic format, including electronically received documents, and document each stage of credentialing/recredentialing process thoroughly
Develops and maintains good working relationships with practitioners and support staff to obtain necessary and timely information to facilitate the provider enrollment/reenrollment process if applicable
Works collaboratively with fellow team members to maintain department workflows, processes, policies and systems. Additionally, each team member is expected to cross-train on location and provider type / group or plan type requirements to assist one another in completing assigned duties as the enrollment cycle warrants
Ability to independently resolve problems, make decisions, and negotiate issues as needed
Tracking of provider credentialing/recredentialing applications timely for the closure of practitioner files
Competence in displaying superior customer service skills
Produce an end-of-day report identifying activities accomplished to be copied to the CEO for review