Credentialing Coordinator
2 weeks ago
Terms of Employment
- Contract, 6 Months (Potential for Extension / Possible Conversion)
- This position is primarily remote. Candidates must reside within a commutable distance to facilitate occasional onsite work for training, team meetings, and collaboration sessions.
Overview
nTech Solutions, Inc. is seeking a Credentialing Specialist to assist in the credentialing process for new practitioners within the Behavioral Health Network. The role involves verifying provider eligibility for program participation and ensuring accurate maintenance of provider data in accordance with industry standards. This position is data-intensive and requires a keen eye for detail, particularly in managing and reconciling data using Excel. The ideal candidate will possess credentialing experience alongside advanced Excel proficiency to enhance the accuracy and efficiency of the credentialing workflow.
Responsibilities
- Manage provider applications from initiation to completion, performing twelve (12) primary source verifications within the credentialing file. Upon completion, data will be entered into the EVIP system, followed by the preparation of a spreadsheet for downstream systems integration with the claims department.
- Address inquiries from both external and internal stakeholders regarding provider eligibility, credentialing status, and updates to provider files. Emphasis on delivering a positive provider experience through timely resolutions and proactive communication.
- Maintain the provider file and electronic records, ensuring that all provider information is current during processes such as credentialing, recredentialing, demographic updates, and terminations.
- Identify, analyze, and resolve any immediate or existing issues related to provider files, ensuring compliance with applicable state laws and departmental guidelines.
- Prepare written communications to request incomplete or missing information and engage effectively via telephone as needed.
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