Credentialing Coordinator (52341)

GLOBALHEALTH HOLDINGS LLC•Oklahoma City, OK

7d•Remote

About The Position

The Credentialing Coordinator is responsible for coordinating and maintaining the provider credentialing and recredentialing process to ensure compliance with CMS Medicare Advantage requirements, applicable state and federal regulations, contractual obligations and organizational policies. This role verified provider qualifications, maintains accurate credentialing records, supports timely provider onboarding and collaborates with departments and delegated entities to ensure operational efficiency and regulatory compliance.

Requirements

High School diploma or equivalent required
Three to five years of credentialing experience
Working knowledge of credentialing process and guidelines
Knowledge of primary source verification and sources to obtain
Proficient in computer and applications including Word, Excel, Credentialing Database, Outlook, HAX and other applications as required
Knowledge of credentialing forms and required documentation for application processing
Knowledge of CMS, OSDH, and other accrediting agency standards
Strong data entry skills with high degree of accuracy
Excellent customer service skills and telephone etiquette
Must be able to communicate successfully
Knowledge of types of modalities, specialties, and education required for each practitioner and provider
Ability to maintain accurate database and documentation
Proper organizational/time management skills
Exercises judgment when dealing with applicants by demonstrating the ability to analyze situations and use tact and diplomacy to arrive at resolutions
Strong verbal, written and organizational skills, must be self-directed/self-motivated and must have analytical, problem-solving and decision-making abilities
Ability to learn and retain new skills quickly while maintaining a high level of accuracy.
Must have the following mental abilities: Alertness, precision, analytic ability, problem solving, memory, communication, creativity, concentration, judgment, imagination, initiative and persistence to complete roles and responsibilities.
Must have a helpful, collaborative attitude and a willingness to learn and support overall operations of the department
Must have access to a reliable and secured internet connection source.
Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

Responsibilities

Processes applications and credentialing files, checking for completeness and accuracy.
Obtains primary source verification of competencies relating to the applicant such as relevant board certifications, health facilities affiliations, licensure, certifications, DEA, OBNDD certificates, and malpractice coverage following GlobalHealth Policy and Procedures including NCQA requirements.
Queries and processes primary source verification and accreditation information including NPDB, OIG, SAM, Revoked Medicare Providers & Suppliers and Medicare Opt Out.
Emails or faxes GlobalHealth Provider Data Forms or UCA applications for initial credentialing and reappointment when requested.
Downloads provider application and all available primary source verified documents from CAQH.
Prepares credentialing files and submits practitioner and provider information to Credentialing Committee for approval in timely manner.
Continuously maintains and updates accurate credentialing files and database for both practitioners and providers.
Maintains communication with appropriate practitioners to ensure records are up-to-date and consistent.
Assists Supervisor of Credentialing, and other leaders and Executive Credentialing Committee to ensure that proper credentialing procedures are followed.
Notifies practitioners and providers of Credentialing Committee decisions and renewal dates and responds to request for status of credentialing.
Manages, requests and follows up expirable as needed (license, COI, Board Certifications, etc.).
Saves approved documentation, files to the credentialing drive, and keeps all appropriate records in provider folders.
Maintains confidentiality of all credentialing files.
Completes various work assignments as requested by supervisor in a timely manner.
Maintains current desk procedures and reference materials.
Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
Performs other duties as assigned.