Credentialing Office Coordinator

4 weeks ago

Warminster, United States National Medical Reviews Full time
Job DescriptionJob Description

Role and Responsibilities:

Credentialing:

  • Facilitates all aspects of the peer reviewer credentialing process
  • Builds, maintains and updates the peer reviewer panel
    1. Continuously recruits new peer reviewers to ensure a full and well-rounded panel
      • Sends out general marketing brochures and files returned responses
      • Prepares and mails informational / credentialing packages to potential peer reviewers
    2. Reviews and processes credentialing applications for new peer reviewers
    3. Performs re-credentialing of existing peer reviewer panel members
    4. Performs and records primary and secondary source verification of peer reviewer credentials
    5. Creates and maintains peer reviewer files, ensuring that files are complete
    6. Documents the findings of the Chief Medical Director regarding applicants’ / peer reviewers’ applications for credentialing and/or re-credentialing
    7. Advises peer reviewers of deadlines / timeframes for re-credentialing
    8. Tracks pending termination actions to be taken against a peer reviewer
  • Acts as a resource to peer reviewers and staff regarding the peer reviewer credentialing process
  • Ensures the thoroughness, confidentiality and secure storage of peer reviewer files within the panel database, and provides retrieval of information as requested
  • Participates in various special projects, as necessary (e.g., formulating specialty coding lists, revising the panel database, etc.)
  • Assists the Vice President of Compliance in the development and updating of credentialing and peer reviewer policies and procedures, as requested

Administrative:

  • Greets all office visitors, delivery and service providers
    1. Ensures that all visitors have signed in/out via the visitor log book
    2. Escorts all visitors through the office to a secure conference room or staff member office
    3. Ensures that all delivery and service providers are escorted through the office at all times during the course of their delivery or service call
  • Answers and directs incoming telephone calls and faxes, as needed
  • Assists accounting department with bookkeeping
  • Scanning documents and records
  • Processes incoming and outgoing mail and overnight deliveries
  • Monitors and maintains inventory of office supplies
  • Monitors and maintains postage meter levels
  • Travels locally to purchase office supplies and/or for postal and banking activities, as needed
  • Assists with mass mailing marketing projects, as requested
  • Participates in quality improvement activities
  • Performs General Office Duties
  • Performs other related duties, as assigned

Education, Training and Experience:

  • High school diploma or its equivalent
  • Experience with the process of professional credentialing
  • Experience with, and a high level of comfort in, communicating with physicians
  • Excellent verbal, interpersonal, communication, organizational and customer service skills
  • Above average computer skills in Microsoft Office applications
  • Detail oriented

Physical Demands:

  • Must be able to both speak clearly and hear, as frequent use of the telephone is required
  • Must have sufficient close-vision capabilities and use of hands in order to perform computer tasks
  • Must be able to sit for extended periods of time
  • Must be able to work under conditions of occasional stress in order to meet deadlines

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