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Credentialing Coordinator
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The credentialing coordinator is responsible for leading, coordinating, monitoring, and maintaining the credentialing/re-credentialing process for all payers and all providers in the Humboldt Park Health Partners network. The coordinator will ensure interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.
Essential Duties and Responsibilities:
Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, to ensure completed credentialing for all payers.
Identifies issues provider applications that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Prepares Universal Provider roster template for completion to the payers and submits monthly to all contracted Payors via the appropriate submission process established by the Payor.
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.
Performs data entry into Quick Cap v7 credentialing module provider’s demographic information utilizing the CAQH credentialing database, optimizing efficiency, and accuracy and ensures all credentialing fields are populated.
Tracks all credentialing statuses with all payers for all providers utilizing the Quick Cap v7 credentialing module. Reviews and follows up via e-mail as necessary to payers to ensure credentialing is complete with the ability to explain why there is a delay.
Submits weekly updates to all clinics and business office to ensure that everyone is aware of credentialing statuses for the providers.
Qualifications:
High School Diploma or Equivalent
Minimum of 1 -3 years of related experience
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