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Credentialing Coordinator

3 months ago

Charlotte, United States Metrolina Nephrology Full time

A non-exempt office position responsible for the credentialing of all providers (Physicians and Advanced Practitioners) within practice, and relevant administrative support to providers (Physicians and APP's).

Includes, but not limited to:

  • Coordinate initial provider credentialing for all NEW providers per the company Credentialing Policy for all entities needed/requested per the provider's contract and schedule.
  • Initiate new provider setup including but not limited to: credentialing file, compile documents, coordinate/schedule headshot, equipment needs, acquire web profile "area of interests".
  • Maintain provider licensure and renewals as needed.
  • Coordinate necessary training requirements for providers to receive and maintain privileges at facilities.
  • Process all re-credentialing applications of hospital systems and dialysis companies.
  • Track down approval letters/confirmation of privilege status at all outside facilities. Follow up as needed.
  • Assist with the collection, completion and distribution of all peer reference requests from hospital systems and dialysis companies.
  • Maintain individual credentialing file for all providers to include all necessary and up to date working documents.
  • Keep current health records for all providers in credentialing file and distribute as requested/needed.
  • Maintain CAQH database for providers up to date information, documents and attestations.
  • Handle all insurance attestation/document requests. Fulfill insurance carrier requests for demographic/provider database updates.
  • Manage calls/emails from outside facilities for provider document requests and schedules.
  • Report delinquent hospital medical record notifications to relevant provider and Director of Quality & Compliance.
  • Ensure all relevant licensure is posted at respective office location.
Requirements
  • This position requires professional and timely communication with providers and outside partners with whom we provide services to.
  • Must be able to process many applications concurrently and maintain forward momentum with them all. This includes hospitals, dialysis units and also insurance carriers such as BCBS and Medicare etc.
  • Highly organized, proficient in Microsoft Office, Outlook and credentialing software. We are currently transitioning to a new program.
  • Experience: Minimum three years of experience in managed care and hospital credentialing. Minimum three years in the health care industry.
  • Education: Associates degree in healthcare or any combination of education, training and experience that demonstrates the ability to perform the duties of the position.