Healthcare Provider Credentialing Coordinator
3 weeks ago
Healthcare Provider Credentialing Coordinator
About the Role:
- We are seeking a highly organized and detail-oriented Healthcare Provider Credentialing Coordinator to join our team at Clarity Clinic. In this role, you will be responsible for coordinating and maintaining the external credentialing and re-credentialing processes for our healthcare professionals.
- You will work closely with our credentialing company and human resources department to ensure seamless communication and efficient processing of credentialing applications.
- Your expertise in verifying professional training, certifications, and licensing of healthcare professionals will be invaluable in ensuring compliance with state and federal regulations.
Key Responsibilities:
- Process initial credentialing and re-credentialing applications by obtaining all necessary paperwork and documentation from providers and their malpractice insurers.
- Collect and verify pertinent information from applicants, including licenses, DEA numbers, and COI renewals, to assist in their credentialing applications.
- Maintain accurate and up-to-date provider files, including CAQH database files, to ensure timely completion of governmental and commercial payer credentialing applications.
- Establish and maintain individual provider profiles on CAQH, PECOS, NPPES, and CMS databases, ensuring accuracy and compliance with regulatory requirements.
- Complete revalidation requests issued by government payers and work closely with the Director of Reimbursement and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
Requirements:
- A minimum of 2 years of experience in physician credentialing, preferably in a medical group or hospital setting.
- Working knowledge and understanding of medical insurance industry and managed care organizations.
- High school diploma or general education degree (GED) required; Bachelor's degree preferred.
Salary and Benefits:
The salary for this role is estimated to be around $25-$32 per hour, commensurate with experience. Our comprehensive benefits package includes health, dental, vision, EAP services, and more. We also offer a $100 monthly wellness reimbursement stipend, 401(k) match up to 4%, and 10 days of PTO plus 5 sick/wellness days and 6 holidays.
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