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Credentialing Operations Coordinator

2 months ago

Tampa, Florida, United States Women's Care Full time

Job Details

Overview

Women's Care, established in 1998, stands as a premier women's healthcare organization in the United States, committed to delivering exceptional care throughout women's reproductive stages and beyond. With over 100 locations and a network of more than 400 OB/GYNs and specialists nationwide, Women's Care offers extensive patient services in areas such as obstetrics, gynecology, gynecologic oncology, urogynecology, gynecologic pathology, breast surgery, genetic counseling, maternal fetal medicine, laboratory services, and fertility treatments.

The Credentialing Coordinator plays a vital role within the Provider Contracting Team. Reporting directly to the Credentialing Director, this position is responsible for managing the entire provider credentialing and re-credentialing process in accordance with industry standards. While this role is remote, candidates must reside in one of the following states: AZ, CA, FL, GA, IL, MD, MO, PA, TN, TX, KY, NC, ND, OR, or WI

  • Gather necessary credentialing documentation from providers to facilitate the health plan application and participation process.
  • Reach out to health plans to request credentialing applications.
  • Submit initial credentialing documents and follow up with health plans to confirm receipt and processing.
  • Manage the provider re-credentialing process as required.
  • Notify health plans of any changes regarding providers, including updates to names, facilities, and addresses.
  • Address health plan inquiries related to credentialing promptly.
  • Oversee CAQH applications, ensuring completion and updates are made as necessary.
  • Maintain accurate records of physician files and credentialing documents.
  • Process Commercial, Medicaid, and Medicare enrollment applications and/or delegated rosters.
  • Handle NPI updates efficiently.
  • Assist with revenue cycle issues arising from enrollment, such as provider ID and status.
  • Uphold and embody the mission and core values of Women's Care.
  • Ensure compliance with all HIPAA regulations and guidelines.
  • Perform additional duties as assigned.

Qualifications

Required Qualifications:

  • High School Diploma or equivalent required; Associate's degree preferred.
  • 2-3 years of experience in managed care credentialing, particularly with Medicaid and Medicare.
  • Proficient in Microsoft Office and a quick learner of other computer systems.
  • Strong communication, professionalism, and organizational skills, coupled with a solid customer service orientation.
  • Ability to cultivate and maintain relationships with various levels of internal and external stakeholders.
  • Self-motivated with the capacity to manage multiple projects and activities effectively.
  • Detail-oriented and capable of working independently in a dynamic environment.
  • Critical thinking skills with strong organizational capabilities, along with proficiency in documentation workflows and procedures.
  • NAMMS certification is a plus.
  • Familiarity with CredentialStream is advantageous.
  • Dependability, reliability, and punctuality are essential.

Why Choose Women's Care?

We Provide:

  • Competitive compensation package
  • Comprehensive health, dental, and vision benefits
  • Paid time off and holidays
  • 401k retirement plan
  • An opportunity to positively impact patients' lives on a daily basis

Women's Care has experienced significant growth over the years and aims to continue expanding into new markets. With the dedication of our team members, we remain committed to our mission of 'Improving the Health of Women Every Day.' At Women's Care, we CARE about our patients and uphold our core values.

C ompassion & Empathy: Treating patients as valued friends and family

A ccountability: Taking responsibility for our actions and behaviors

R espect: Acting with respect in every interaction

E xcellence & Quality: Delivering the safest, highest quality of care