Payer Credentialing Coordinator
2 weeks ago
Medical facility is looking for an experienced Payer Credentialing Coordinator.
The Payer Credentialing Coordinator is responsible for day to day credentialing tasks to Include payer enrollment, revalidations, and other miscellaneous tasks as required by payers; serves as initial point of contact for contracted providers, insurances and other related entities. Performs a variety of tools in order to research and resolve provider enrollment issues. Assist with policy and procedure interpretation.
Essential Duties/Responsibilities:
- Reviews and screens initial and reappointment credentialing applications for completeness and accuracy; reviews files for compliance and quality standards, accreditation requirement and all other relevant policies.
- Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and criteria.
- Maintains database from provider applications with accuracy and maintains reporting information regarding provider enrollments in process.
- Retains records related to completed payer credentialing applications.
- Work closely management and other resources to expedite completion of payer credentialing forms and other requirements such as obtaining signatures, locating required documentation, etc.
- Identifies, analyzes and resolves discrepancies, time gaps and other related issues that have an impact to payer credential and enrollment of practitioners.
- Communicates problems to payers, credentialing contractors, or others as needed.
- Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
- Communicates clearly with payers, providers, their liaisons, and other departments as needed to provide timely responses upon request as credentialing and privileging issues arise.
- Performs other duties as assigned.
- Two years of payer credentialing experience required.
- License/Registration/Certification
- Certified Provider Credentialing Specialist (CPCS) preferred.
- Associate's degree in related field required.
Position will run for 6 weeks possibly longer.
#ELPSO70#
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