The Credentialing Coordinator is responsible for completing the Managed Care Credentialing/Recredentialing applications in a timely and accurate fashion. The Coordinator is responsible for follow-up to ensure that the physician is enrolled on the contracted managed care plans.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Responsible for creating Physician Reference Guides (PRG) in the department’s Access Credentialing Database for new physicians.
- Responsible for CAQH on-line credentialing set up and maintenance efforts.
- Accurate and timely submission of Managed Care Credentialing & Recredentialing applications for physicians and paraprofessionals.
- Timely follow-up phone calls & documentation on a monthly basis to verify that credentialing applications have been received, until effective date is obtained.
- Composing email notifications regarding participation effective dates for providers to appropriate market contacts, office & billing staff members.
- Responsible for developing and updating Contract Summary Sheets with physician effective dates.
- Responsible for requesting expired information for providers on a monthly basis to keep credentialing up to date.
- Responsible for updating the Recredentialing portion of the database and auditing plans quarterly to ensure all recredentialing efforts are current.
- Updating Managed Care Monthly (MCM) Updates with provider’s effective dates.
- Notifying Managed Care plans regarding practice changes such as add/term locations & add/term providers and completing monthly follow up phone calls & documentation on open requests, until process is complete.
- Assist other departments with credentialing and contracting issues as it pertains to claims.
- Other duties may be assigned as the managed care industry changes.
- Must be proficient in MS Office.
- Advanced Excel Skills are required.
- Must have legible printing/handwriting.
- Good organizational, time management and communication skills.
- Must be able to effectively communicate with physicians, co-workers, supervisor, and outside contacts.
- Must be able to handle multiple tasks in a fast paced environment.
- Work independently with minimal supervision.
- Adheres to company policy and procedures.
- Must be able to understand and speak English Fluently.
EDUCATION AND/OR EXPERIENCE:
- Must have a High School Diploma or equivalent.
- Applicant must have credentialing experience in a physician office or health plan environment.
- Experience working with Access is helpful, but not required.
- Must be able to fluently speak, read and understand English.
Job Description Clause
The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.