Credentialing Coordinator

HealthDrive•Framingham, MA

1d•$20

About The Position

This position will be responsible for the credentialing and re-credentialing of all provider types with Medicare, Medicaid, and other third-party payers, managing the process, and maintaining up-to-date credentialing information. Additionally, this position will work on project work in Regulatory Affairs with some minor administrative duties.

Requirements

Must have excellent communication skills: verbal, interpersonal and written. This includes strong spelling and grammar skills and basic mathematical calculations.
Must have strong ability to self-direct and work independently in a high-volume, deadline-driven role.
Customer orientation: establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
Policies & procedures: articulates knowledge and understanding of organizational policies, procedures, and systems.
PC Skills: demonstrates proficiency in Microsoft Office (Excel, Access, Word) applications and other as required.
Outstanding organizational skills and attention to detail.
Ability to maintain confidentiality of privileged information gained.
Excellent judgment & prioritization skills proactively prioritize needs and effectively manages resources.

Nice To Haves

Prior medical admistrative experience
Insurance payer credentialing experience or knowledge
Knowledge of PECOS, Medicare, NPPES, CMS, NPI Registry

Responsibilities

Maintains high-quality, up-to-date, and accurate credentialing processes for all provider types.
Assists in the credentialing process by entering/logging/scanning information into Credentialing application for initial, updated, and maintenance processes (license/certification renewals), including verifications.
Processes and maintains credentialing and re-credentialing in accordance with Joint Commission standards and State and Federal Regulatory regulations.
Monitors collection of all information received; follows up on missing items and/or incomplete forms, submits follow-up requests for verifications as needed.
Identifies potential red flags and works in collaboration with the Onboarding Coordinator to document the issue and provider response.
Maintains all credentialing files, ensuring that all correspondence in the credentialing and recredentialing process is accurately filed.
Enter and maintain provider information and documents in company’s third-party credentialing vendor’s portal.
Works with and assists company’s third - party credentialing vendor for accurate and timely completion of payer applications, collection of provider signatures, and tracking of payer credentialing until approvals received.
Assist with credentialing related to new payer contracting.
Other duties and responsibilities as assigned.