Credentialing Coordinator

CU Medicine•Aurora, CO

2d•Hybrid

About The Position

University of Colorado Medicine (CU Medicine) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado. Due to the nature of this role, we will only consider candidates who currently reside in Colorado or those with firm plans to relocate to Colorado. This job offers a primarily remote work structure with on-site work required as dictated by the needs of the job, typically twice a year at minimum. We are seeking a highly motivated Credentialing Coordinator to join our Health Plan Development team. The Credentialing Coordinator will credential and recredential CU SOM employed faculty under the CU Medicine Practice agreement applying NCQA and URAC policies. This processing is to ensure high quality care is provided to members of the Managed Care Organization (MCO)/commercial panels that delegate these processes to the CU Medicine Credentialing team and to facilitate billing and collecting through CU Medicine.

Requirements

Knowledge of NCQA policies required
1-2+ years of credentialing experience highly preferred
Strong PC applications experience required, Salesforce experience preferred
Must be able to communicate verbally and in writing in a concise manner with internal and external parties
Must be able to travel onsite twice a year for team meetings, and any other ad hoc onsite meetings as needed.

Responsibilities

Manage daily processing of CHCPCA credentialing applications for initial and recredentialing processing.
Ensure each file is processed in compliance with NCQA/URAC/CMS from the CVO or conduct the PSV verification; manage each application for accurate primary source verifications (PSV), supporting documents and/or explanations from the practitioner.
Analyze each file for completeness, problem issues (i.e., litigation reviews, sanction information, etc.) and ensures confidentiality of such information.
Monitors the Credentialing Verification Organization (CVO) for complete PSV info and checks-in all PSV info in each file, also recording all entries in Salesforce.
Coordinate the agenda for the monthly CU Medicine Credentialing Committee meetings for review and approval/denial of all files as well as any follow-ups requested by the Committee members. Perform follow-ups required from the meetings, data entry, filing, etc.
Draft minutes from committee meetings
Provide back-up for all MCO annual audits, if necessary.