Credentialing Coordinator

South Florida Community Care Network LLC•Sunrise, FL

1d•$19 - $22•Hybrid

About The Position

The Credentialing Coordinator is responsible for the timely and compliant re-credentialing (renewal) of physicians and allied providers according to state and federal requirements, NCQA accreditation standards, Medicare and Medicaid guidelines, and Community Care Plan (CCP) Credentialing policies and procedures.

Requirements

One (1) year provider credentialing or onboarding experience, or combination.
Must have working knowledge of managed care or healthcare environment.
Records and/or database management experience.
Microsoft Word and Excel experience.
One (1) year of customer service experience.
Analytical skills
Detail-oriented
Self-directed
Exhibit independent judgment
Results-oriented
Self-motivated
Communicate proficiently in English
Professional oral and written communication skills
Project management skills
Information research skills
Define problems, collect data, establish facts, and draw valid conclusions
Read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents
Respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community
Maintain strict confidentially and handle sensitive information
Ability to learn new applications to function effectively in a remote work environment
Establish priorities with independent coordination of day-to-day aspects

Nice To Haves

Associates degree, or equivalent combination of education and experience

Responsibilities

Re-credentials existing providers in all applicable lines of business from inception through completion.
Contacts providers and designated credentialing administrators to obtain all necessary documentation to re-credential providers in a timely fashion to ensure no gaps between cycles.
Validates documents to ensure accuracy of all credentialing elements, completeness of information, and qualifications relative to accreditation credentialing standards, state and federal guidelines, and CCP criteria.
Updates and maintains data provider records in credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
Electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of recredentials in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
Responsible for Epic Tapestry Customer Relationship Management (CRMs) requests for terminations, updates, and other credentialing tasks.
Screen providers across various systems, platforms, and databases such as the National Practitioner Database (NPDB), System for Award Management (SAM), the Office of Inspector General (OIG), the Agency for Healthcare Administration (AHCA), Social Security Death Master File (DMF), NPI registry, and the Florida Medicaid Provider Master List (PML).
Conducts board certification and Florida state licenses and certifications primary source verifications.
Confirms provider hospital affiliations, malpractice insurance or self-insurance status, and Tax Identification Number.
Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to re-credential providers.
Maintains inter-departmental relationships with Provider Operations and Provider Data Management teams to ensure efficient, timely, and accurate processing of provider applications, and network enrollments, updates, and terminations.
Reports problems to Credentialing Management and makes sound decisions in accordance to credentialing policies and procedures, federal, state, local and government/agency regulations.
Responds to internal and external inquiries regarding credentialing status.
Participates in credentialing projects with selected provider groups and subcontracted vendors.
Assists providers on the Credentialing Hotline and respond to voicemails in a timely fashion, usually within 24-48 business hours.
Maintains professional growth and development through seminars, workshops, professional affiliations, and self-education, including staying current with department policies and procedures, to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
Perform miscellaneous job-related duties as assigned.