Credentialing Coordinator

HN1•Miami, FL

About The Position

This position is responsible for the initial credentialing and re-credentialing of network providers, and for the maintenance of provider credentialing files, electronically and on paper. Complies with the HS1 Credentialing Program Description which meets NCQA requirements.

Requirements

High school diploma or general education degree (GED)
Two years or more of managed care credentialing experience.

Nice To Haves

College experience preferred.
Bilingual English/Spanish preferred

Responsibilities

Receive and process all credentialing/re-credentialing applications according to Company policies and procedure.
Maintain accurate and complete records as to the status of each application.
Data Entry of provider information into the computer system.
Prepare new provider applications and re-credentialing applications for the Credentialing Committee to review.
Attends Monthly Credentialing Committee meetings as needed and assist in preparation for meeting.
Maintain initial and re-credentialing established timelines
Communicate with providers to update expired credentials, clarify information and other credentialing related issues for initial and re-credentialing.
Maintain a strict level of confidentiality for all matters pertaining to provider credentials.
Ensures compliance with and/or adheres to company HIPAA policies and procedures.
Ensures integrity of data entered into company systems and/or databases.
Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
Ability to come to work and work the regular schedule and shift for the position.
Compliance with all personnel policies and procedures.
Perform additional duties and related essential duties as assigned.