Credentialing Coordinator

We are seeking a highly skilled Credentialing Coordinator to join our team at eTeam Inc. as a Medical Professional Credentialing Specialist. In this role, you will be responsible for ensuring the timely and accurate processing of all providers, including nurse practitioners, physician assistants, and physicians, in accordance with Joint Commission accreditation, NCQA, and URAC credentialing standards.

• Initial credentialing and re-credentialing of medical professionals, including primary source verification methods, compliance monitoring, and expireables management.
• Monitoring of expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA, and URAC credentialing standards.
• Timely and accurate processing of all providers, including NP's/PA's/MD's initial and re-credentialing applications.
• Monitoring of licensure reporting, database tasks, and system updates, with weekly reporting to leadership.
• Management of Epic access for providers with out-of-compliance licensure and/or board certification.
• Conducting sanctions and compliance monitoring, and alerting Credentialing Manager and Revenue Director of any undisclosed negative findings.
• Processing malpractice insurance verification requests according to internal policies.
• Maintenance of provider and physician SharePoint sites, and communication of provider status with leadership and other internal teams to meet timelines.
• Submission of system access requests upon credentialing approvals/clinic eligibility.
• Support of the payer enrollment team as needed to resolve any payer claim issues.
• Monitoring of Provider and Clinic change/Termination reports, and update of database accordingly.
• Processing of Name changes according to client's policies and procedures.
• Daily maintenance of provider credentialing grids with notification to appropriate teams.
• Review and distribution of all incoming mail as needed.
• Support of Payer Audits in accordance with client's, Joint Commission, and NCQA requirements.
• Maintenance of provider files with the most current information/documentation.
• Notification of system analyst and leadership of any system and state agencies interruptions/updates/password changes.
• Recommendations for process improvement and system efficiencies.
• Attendance and engagement in all team meetings.
• Modeling of a positive attitude in interactions with team members.

• Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals, including primary source verification methods, compliance monitoring, and expireables management.
• Understanding of Joint Commission Accreditation, NCQA, and URAC credentialing standards.
• Ability to function independently and utilize critical thinking skills to accomplish goals and objectives.
• Effective communication skills; verbal and written.
• Strong interpersonal skills, including the ability to work well with internal and external stakeholders.
• Strong organizational skills and the ability to multitask.
• Competent user of Microsoft Office, Outlook, Word, and Excel.
• A minimum of 3 years experience in the healthcare industry with experience in credentialing.

• NAMSS Certified Professional Credentialing Specialist (CPCS) certification.
• Education - Verifiable High School Diploma is required.