Credentialing & Enrollment Coordinator
About The Position
Processes and submits complete, timely and accurate applications and rosters to the appropriate constituents directly. Interprets and assists in implementing the standards of the National Committee for Quality Assurance (NCQA). Maintain and audit credentialing software and data integrity and updates database accordingly. Processes requests and prepares correspondence to health plans through monthly communications. Serves as the first contact when communicating with practices and health plans regarding enrollment issues and directory listings. Performs health plan quarterly, semi-annual, and annual audits. Maintains current licensure, certifications, malpractice insurance, and any other applicable regulatory items at time of appointment and continuous maintenance going forward to ensure timeliness, accuracy and integrity of the credentialing database system and compliance with the regulatory agencies.
Requirements
- Must be tech savvy, a self-starter, detail oriented, and have solid critical thinking skills.
- High School Diploma or GED required
- Previous experience as a Credentialing Coordinator or Provider Enrollment
- Knowledge of NCQA standards and guidelines.
Nice To Haves
- Bachelor's Degree preferred.
- Certification by National Association Medical Staff Services or Certified Provider Credentialing Specialists preferred.
Responsibilities
- Processes and submits complete, timely and accurate applications and rosters to the appropriate constituents directly.
- Interprets and assists in implementing the standards of the National Committee for Quality Assurance (NCQA).
- Maintain and audit credentialing software and data integrity and updates database accordingly.
- Processes requests and prepares correspondence to health plans through monthly communications.
- Serves as the first contact when communicating with practices and health plans regarding enrollment issues and directory listings.
- Performs health plan quarterly, semi-annual, and annual audits.
- Maintains current licensure, certifications, malpractice insurance, and any other applicable regulatory items at time of appointment and continuous maintenance going forward to ensure timeliness, accuracy and integrity of the credentialing database system and compliance with the regulatory agencies.
Benefits
- Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
- Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance
- Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
