Credentialing Coordinator

The Credentialing Coordinator will work under the supervision of the Manager of Credentialing. This position works closely with CARD satellite centers, clinics, and departments to provide them support and assistance with enrollment and credentialing for all CARD providers in managed care plans. This position initiates all tasks related to the enrollment and credentialing functions, including continuous monitoring of provider’s credentials and related requirements for their respective job roles. This is a full- time, hourly, non-exempt position. This position is expected to represent CARD professionally and ethically to internal and external stakeholders.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Facilitate the credentialing and primary source verification process for the initial and recredentialing of providers in accordance with state and federal regulations and accreditation and CARD standards

• Complete and submit provider payer applications, initial, re-credentialing and assist with obtaining attestations from providers

• Monitor status of various provider credentials and related requirements and obtain current documentation to ensure ongoing compliance with network participation requirements

• Processes applications expeditiously and efficiently according to the established priorities and time frames

• Maintain up-to date data for each provider in credentialing databases and related systems

• Track progress of provider applications and provide timely follow up with providers and payers, as needed

• Communicate with stakeholders (external and internal) insurance companies and other agencies required via phone and email

• Provider Data Management. Support internal stakeholders on the loading and validation of their data.

• Create reports which are submitted to external stakeholders on departmental data and provider records

• Ensure accuracy and compliance within all HPPA guidelines

REQUIREMENTS:

• High school diploma or equivalent required

• Associate or bachelor’s degree preferred

• 2 + years of work experience with provider enrollment/credentialing preferred, but not required

KNOWLEDGE, SKILLS, AND ABILITIES:

• Excellent written and communication skills

• Knowledge of Excel, Word and PowerPoint necessary

• Experience with Customer Service whether the “customer” is internal or external

• English proficiency, both verbal and written, is required

WORK ENVIRONMENT:

• Includes a typical remote office environment, with minimal exposure to excessive noise or adverse environmental issues.

PHYSICAL REQUIREMENTS:

• Ability to sit for prolonged periods of time

• Ability to work on a computer throughout the majority of the day, as tasks require

• Ability to use and speak on the phone, as needed throughout the day