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Credentialing Coordinator
2 months ago
CCI Health Services was founded in 1972. As a 501c (3) non-profit organization that brings high-quality and affordable healthcare to every patient during all stages of life, we are also a diverse and inclusive workplace grounded in community. As a Federally Qualified Health Center (FQHC), our mission is to lead the way to a more equitable healthcare system for everyone. Located in the DC Metro area, CCI seeks to hire professionals who are passionate about health care. Additionally, CCI Health Services:
- Has 7 health center sites in underserved communities throughout Prince George's and Montgomery Counties serving over 34,000 patients.
- Oversees several federal, state, and county contracts and/or grants that focus on clinical operations, patient outcomes, and access to care and services.
- Provides health assessments for refugees, asylees, and special visa holders for the state of Maryland. The program currently sees around 2,100 patients on an annual basis.
The Credentialing Coordinator will be responsible for credentialing new and established health care providers, maintenance of information to include in application completion, follow up, data collection, data entry, and document review. Depending on the skillset and experience of the candidate selected, there may also be the opportunity to perform provider enrollment duties.
Key Functions & Responsibilities:
- Maintain provider database/spreadsheet to ensure that all healthcare providers are licensed, and properly credentialed according to regulatory guidelines.
- Process initial and reappointment credentialing applications, including verifying healthcare provider information and licensing, National Practitioner Database (NPD) and other required documentation ensuring that all regulatory requirements are met.
- Coordinate with medical staff personnel to ensure that contract providers and allied health professionals are properly licensed and credentialed.
- Track provider certifications, licensure expiration dates and other expirable documentation, ensuring that all healthcare providers maintain current credentials and are in compliance with regulatory standards.
- Adhere to department policies and procedures including timely delivery of completed work and use of resources.
- Establish and maintain data entry in Credentialing for Affordable Quality Healthcare (CAQH).
- Maintain good rapport and professional communication with Health Plan Representatives.
- Support provider enrollment staff with Medicare, Medicaid, and commercial insurances for Maryland.
- Communicate with healthcare providers and external agencies regarding licensing and credentialing requirements and ensure ongoing compliance with regulatory guidelines.
- Work with physicians, professional staff and physicians' office staff to acquire necessary materials and information.
- Support Provider Enrollment Specialist with insurance updates and enrollment.
- High school diploma or equivalent required.
- Experience with state, federal, and accreditation entity regulations and requirements related to credentialing and privileges.
- Certification in Medical Staff Services (CMSS) or Certified Provider Credentialing Specialist (CPCS) preferred.
- Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances
- Minimum of 3 years' experience in credentialing and provider enrollment at a healthcare facility; experience in a Federally Qualified Health Center preferred
- Ability to prioritize tasks and work independently.
- Excellent verbal and written communication skills.
- Strong organizational and analytical skills, with attention to detail.
- Knowledge of credentialing software and databases.
Why Work at CCI? - Extensive benefits plan
- Generous PTO Plan
- 403B Retirement Plan + Employer match up to 4%
- Tuition Reimbursement
- Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
- Our providers are insured for malpractice under the Federal Tort Claims Act
** CCI Health Services is an Equal Opportunity Employer **
Founded in 1972, CCI Health Services is a diverse and inclusive workplace grounded in community. Located in the Washington, DC Metro Area, each year CCI cares for more than 60,000 individuals in Montgomery and Prince George's Counties. As a non-profit, CCI is committed to improving health equity through the provision of affordable primary care for all, across all stages of life. Visit ccicares.org for more information.
