Provider Coordinator (52303)

GLOBALHEALTH HOLDINGS LLC • Oklahoma City, OK

5d • Remote

About The Position

The primary goal of the Provider Coordinator is for quality assurance of the provider data integrity, for responses to provider inquiries with research and resolution, and to ensure proper categorization of provider directory. This role supports credentialing and provider relations activities while ensuring the accuracy, timeliness, and compliance of the provider directory. This role partners cross-functionally to maintain data integrity and meet CMS regulatory requirements for provider data accuracy and accessibility.

Requirements

• High School diploma or equivalent required
• Three to five years of credentialing experience
• Ability to manage multipole priorities and meet deadlines in a fast-paced environment.
• Knowledge of CMS, NCQA and state regulatory requirements related to provider credentialing and directory accuracy.
• Demonstrated proficiency in the use of personal computer applications; specific skills to include Microsoft Word, Outlook, Excel v-lookup, and ability to build and compare files.
• Ability to quickly develop rapport and work effectively and professionally with all levels of personnel.
• Ability to investigate/research problems and issues and to recommend associated corrective actions.
• Ability to manage sensitive or confidential information in a professional and discreet manner.
• Exercises judgment when dealing with applicants by demonstrating the ability to analyze. situations and use tact and diplomacy to arrive at resolutions.
• Proper organizational/time management skills
• Strong verbal, written and organizational skills
• Must have the following mental abilities: Alertness, precision, analytic ability, problem solving, memory, communication, creativity, concentration, judgment, imagination, initiative, resilience to push through barriers to the solution.

Nice To Haves

• Preferred experience with Medicare Advantage plans
• Working knowledge of credentialing processes and guidelines primary source verification and Knowledge of types of modalities, specialties, and education required for each practitioner and provider
• Must be self-directed/initiative-taking and must have analytical, problem-solving and decision-making abilities.

Responsibilities

• Verify Provider Data integrity with on-going monitoring and responds to daily inquiries in a timely manner.
• Assists in maintaining accurate Provider/Vendor records and Provider Directory
• Educate and assist providers to maximize data integrity and provider experience.
• Actively participates and assists in meeting CMS guidelines.
• Responses, researches and resolves Provider Inquiries within JIRA and other sources.
• Serves as a point of contact for provider data updates and corrections.
• Coordinate initial and recredentialing processes for providers in accordance with OK and CMS standards.
• Tracks credentialing timeliness and ensure compliance with turnaround requirements.
• Processes applications and credentialing paperwork, 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 Credentialing Policy and Procedures including CMS requirements.
• Queries and processes of primary source verification, verification, and accreditation information including NPDB, OIG, SAM, and Medicare Opt Out.
• Emails, faxes, or mail provide communications.
• May prepare credentialing files and submit practitioner and provider information to Credentialing Committee for approval in timely manner.
• May support review of credentialing files and databases for both practitioners and providers.
• Maintains communication with appropriate practitioners to ensure records are up-to-date and consistent.
• 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).
• Collaborate on outreach to providers for data validations.
• Coordinates with delegated vendors to validate provider data accuracy and timelines.
• Support oversight of delegated entity credentialing rosters, and other notifications related to directory accuracy and credentialing timelines.
• Maintains confidentiality of all credential 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.

Benefits

• Genuine Care and Optimal Health for the members we serve
• High touch, high value and a partnership to our members
• Personalized, engaging, and responsive services to our members
• Affordable health insurance coverage with the benefits people truly want and need

What This Job Offers

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