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.
• HS diploma or equivalent
• Minimum of one year accreditation or credentialing experience, preferably in the managed care industry, preferred but not required.
• Knowledge of NCQA and URAC standards preferred
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.