Credentialing Coordinator - Primary Care Facility Credentialing

HealthDrive•Framingham, MA

11h•Hybrid

About The Position

This position will be responsible for the credentialing and re-credentialing of Primary Care providers with facilities and other Credentialing/RA tasks, plus project-based work/various tasks related to Regulatory Affairs. The role involves maintaining high-quality, up-to-date, and accurate credentialing processes for primary care professionals with nursing facilities and hospitals. It also includes assisting in maintaining healthcare professional information in the Credentialing system, preparing and submitting facility credentialing applications, and tracking their status until approval. Additional responsibilities include monthly NPDB renewals/terms, monthly Exclusion screening updates, EDI enrollments, onboarding providers from acquisitions, handling record requests, and weekly QA. The role also involves project-based work such as assisting with payer audits/appeals and payer contract initiation, along with other assigned duties.

Requirements

Outstanding organizational skills and attention to detail.
Excellent judgment & prioritization skills: proactively prioritizes needs and effectively manages resources.
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.
Ability to maintain confidentiality of privileged information gained.

Nice To Haves

Prior credentialing experience

Responsibilities

Maintains high-quality, up-to-date and accurate credentialing processes of primary care professionals with nursing facilities and hospitals.
Assists in maintaining the healthcare professional’s information in the Credentialing system by entering/uploading information and documents.
Prepares facility credentialing applications for healthcare professional’s review and signature; follows up with healthcare professional until completed application is received back; submits the completed applications to the facilities.
Tracks and monitors the status of each credentialing request; follows up with facility until approval is received.
Monthly NPDB renewals/terms
Monthly Exclusion screening updates (hires/terms)
EDI enrollments and monthly hires/terms
Onboarding of providers from acquisitions
Record requests
Weekly QA
Assist the department with various projects as the need arises. Examples of project work include but are not limited to payer audits/appeals, payer contract initiation.
Other duties and responsibilities as assigned.