Credentialing Coordinator

2 weeks ago

Memphis, Tennessee, United States Provident Practice Management Services, LLC Full time
Job Overview

Credentialing Coordinator

Provident Practice Management Services, LLC is looking for a dedicated Credentialing Coordinator to join our team. This role is essential for ensuring that our healthcare professionals maintain the necessary credentials, privileges, and plan enrollments. The position offers a hybrid work environment, allowing for both in-office and remote work.

Key Responsibilities:

  • Manage applications for new and renewed state medical licenses, ensuring all files are current and comprehensive.
  • Facilitate the enrollment of new providers in health plans and handle re-enrollment processes as required.
  • Credential all healthcare providers with associated health plans.
  • Process applications for hospital privileges for all medical staff.
  • Inform schedulers, clinic managers, and physicians about the enrollment status of providers in health plans.
  • Assist the ASC administrator in maintaining accurate ASC provider files.
  • Monitor Provider CME credits and stay updated on state CME requirements.
  • Complete compliance training as mandated by the company and legal requirements.
  • Adhere to HIPAA compliance protocols.
  • Communicate effectively with internal staff and external entities such as MetroCare and State Boards.
  • Perform additional duties as assigned.

Qualifications:

Education and Experience:

A high school diploma or GED; or six months of credentialing experience and/or training; or an equivalent combination of education and experience.

Skills:

  • Ability to read, analyze, and interpret business publications, professional journals, and governmental regulations.
  • Proficient in writing reports, business correspondence, and procedural documentation.
  • Strong verbal and written communication skills.
  • Excellent interpersonal and customer service abilities.
  • Critical thinking skills for problem identification and resolution in a dynamic environment.
  • Competence in basic mathematical calculations.
  • Adept at defining problems, collecting data, and drawing valid conclusions.
  • Proficient in standard business software; experience with EMR is preferred.
  • Strong keyboarding skills.

Personal Attributes:

  • Professional representation of the practice.
  • Punctual and reliable.
  • Team-oriented with a willingness to assist colleagues.
  • Detail-oriented while managing multiple tasks.
  • Maintains confidentiality and demonstrates diplomacy.
  • Strong work ethic and self-motivation.

Physical Requirements:

Ability to sit, stand, or walk for extended periods, as well as perform tasks that require climbing, balancing, lifting, pushing, pulling, and stooping as necessary.

Ability to operate office equipment requiring the use of one hand.

Ability to work in a moderately noisy environment.

E/O/E

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