The Credentialing Coordinator will assist in the organization of all facets of the provider credentialing process with support from a Credentialing Specialist. Ensure provider compliance with credentialing standards. Process and record CareCentrix provider amendments (updated and changes). Answer customer/provider calls effectively and provide exemplary customer service. Establish and maintain good working relationships with providers and ensure the completeness of data. Work under direct supervision. Complete special assignments.
• Data stamp applications received.
• Contact provider to obtain all necessary credentialing elements to ensure completeness.
• Process provider work tickets as assigned. Update system with any important information to ensure that facilities are in compliance with current standards.
• Collect and analyze information.
• Answer and document provider calls. Assure customer agreement by summarizing and closing each call appropriately.
• Coordinate the receipt of provider applications.
• Bundle provider completed files.
• Run OIG and SAM sanction verification and NPDB when applicable.
• Input specified provider data into database and track expiration dates for current file and system maintenance.
• Assist in preparing the credentialing file for all providers.
• Maintain provider files in the Vistar database system as needed.
• Mail provider contracts and notice of determination after credentialing committee.
• Maintain teamwork, customer service production and quality standards to ensure timely, efficient and accurate call resolution.
• Update all systems with current provider id numbers.
• Meet all customer SLA’s on notification to providers with committee decision, and notification if the file is missing credentialing elements.
• Exercise good judgement, and remain knowledgeable in related company policies and procedures.
• Participate in special projects and perform other duties as assigned.
REQUIRED EDUCATION / EXPERIENCE
Requires a HS diploma or equivalent; up to 1 year of previous related experience; or any combination of education and experience, which would provide an equivalent background. A minimum of one year accreditation or credentialing experience, preferably in the managed care industry, preferred but not required. Effective communication skills (both oral and written) are required. Knowledge of NCQA and URAC standards preferred, but not required.
ATTRIBUTES / QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Candidate will possess excellent communication (oral and written), organizational and interpersonal skills.
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
• Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
• Reviews and adheres to all company policies, procedures, and the Employee Handbook.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.