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Credentialing Coordinator

2 months ago

Reynoldsburg, Ohio, United States eTeam Inc Full time
About the Role

We are seeking a highly skilled Credentialing Coordinator to join our team at eTeam Inc. As a key member of our healthcare operations team, you will play a critical role in ensuring the timely and accurate processing of medical professional credentials.

Key Responsibilities
  • Initial credentialing and re-credentialing of nurse practitioners, physician assistants, and physicians in a compliant and timely manner
  • Monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA, and URAC credentialing standards
  • Process malpractice insurance verification requests according to internal policies
  • Manage Epic access for providers with out-of-compliance licensure and/or board certification
  • Conduct sanctions and compliance monitoring, and alert Credentialing Manager and Revenue Director of any undisclosed negative findings
  • Support the payer enrollment team as needed to resolve any payer claim issues
  • Monitor provider and clinic change/termination reports and update databases accordingly
  • Process name changes according to client policies and procedures
  • Daily maintenance of provider credentialing grids with notification to appropriate teams
  • Review and distribute all incoming mail as needed
  • Support payer audits in accordance with client, Joint Commission, and NCQA requirements
  • Maintain provider files with the most current information/documentation
  • Notify system analyst and leadership of any system and state agencies interruptions/updates/password changes
  • Make recommendations for process improvement and system efficiencies
  • Attend and engage in all team meetings
Requirements
  • 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 of experience in the healthcare industry with experience in credentialing
Preferred Qualifications
  • NAMSS Certified Professional Credentialing Specialist (CPCS) certification
  • Education - Verifiable High School Diploma is required