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Credentialing Coordinator

2 months ago

Dallas, United States Signify Health Full time
Job DescriptionJob Description

How will this role have an impact?

This role will report to our Director of Credentialing.

What will you do?

  • Review and screen initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local, and NCQA regulations, guidelines, policies, and standards.
  • 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 Signify Health criteria, while maintaining the confidentiality of all protected health information that may be accessed.
  • Identifies analyzes and resolves extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact the ability to credential and enroll practitioners; discovers and conveys problems to Credentialing Manager/Supervisor/Director.
  • Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
  • Enters, updates, and maintains data from provider applications into the credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses and in accordance with internal policies and procedures.
  • 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 providers, internal/external clients, and all Signify Health staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise.
  • Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest developments to enhance understanding of various regulations and legislation of the healthcare industry and assist with special projects on an as-needed basis.

We are looking for someone with:

  • 3-5 years of successful work experience in a credentialing role
  • NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify. (Preferred)
  • CAQH Experience (Preferred)
  • MD Staff Experience (Preferred)
  • Goggle Suites Experience (Preferred)

The base salary hiring range for this position is $17.00 to $28.00. Compensation offered will be determined by factors such as location, level, job-related knowledge, skills, and experience. Certain roles may be eligible for incentive compensation, equity, and benefits.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. Eligible employees may enroll in a full range of medical, dental, and vision benefits, 401(k) retirement savings plan, and an Employee Stock Purchase Plan. We also offer education assistance, free development courses, paid time off programs, paid holidays, a CVS store discount, and discount programs with participating partners.

About Us:

Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across individuals' clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we're able to close critical care and social gaps, as well as manage risk for individuals who need help the most. This leads to better outcomes and a better experience for everyone involved.

Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify's intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million individuals each year while helping payers and providers more effectively implement value-based care programs.

To learn more about how we're driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com

Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.

We are committed to equal employment opportunities for employees and job applicants in compliance with applicable law and to an environment where employees are valued for their differences.