Credentialing Coordinator

WVU Medicine

3d • Onsite

About The Position

Responsible for timely payer credentialing and/or recredentialing of providers for West Virginia United Health System. This includes, but is not limited to, processing new applications, recredentialing applications, monitoring expiring documents, and monthly monitoring of sanctions.

Requirements

• High School diploma or equivalent and one (1) year of administrative related experience OR Associates, Bachelors or Masters degree in lieu of experience
• Proficient computer skills including but not limited to thorough knowledge of Windows and Microsoft Office including Excel, or similar applications.
• Possess excellent organizational and prioritization skills.
• Must be detailed oriented and possess excellent grammar skills.
• Possess professional communication skills.

Nice To Haves

• Knowledge of NCQA and CMS regulations regarding provider credentialing.

Responsibilities

• Coordinates provider credentialing by tracking applications, keying data into the credentialing program, monitoring information requested from providers, and assisting with preparation of credentials files for review in accordance with NCQA and CMS regulations.
• Performs primary source verification of provider information in compliance with NCQA and CMS standards.
• Maintains working knowledge of NCQA and CMS standards.
• Reviews and analyzes credentialing applications and prepares correspondence requesting additional or missing information.
• Regularly initiates and engages in a variety of discussions with contacts, both internal and external to HPN in order to obtain or relay information concerning network participation, contract activity, and credentialing activity.
• Participates in special projects as assigned by Supervisor.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED