Credentialing Operations Coordinator

2 weeks ago


New Philadelphia, Pennsylvania, United States COMHAR Full time

About COMHAR:

At COMHAR, we are dedicated to delivering health and human services that empower individuals, families, and communities to achieve healthier, self-directed lives. Our organization offers a comprehensive range of recovery-oriented and quality-focused services, from outpatient treatment to residential and day programs, all designed to provide high-quality support tailored to individual recovery journeys.

Position Overview:

The Credentialing Coordinator plays a vital role in ensuring that all employees, contractors, and service providers at COMHAR, Inc. comply with the necessary credentialing standards required for the delivery of services. This position is tasked with developing, implementing, and maintaining effective processes for credentialing and re-credentialing, ensuring adherence to all relevant regulatory standards.

Key Responsibilities:

  • Establish and uphold processes for monitoring and timely completion of credentialing and re-credentialing requirements.
  • Lead and coordinate the review and assessment of applications from healthcare and behavioral health practitioners to confirm eligibility.
  • Manage the credentialing and privileging processes for Licensed Behavioral Health Professionals.
  • Identify and address issues that require further investigation and evaluation.
  • Conduct thorough investigations to validate discrepancies and ensure prompt follow-up.
  • Prepare credential files for timely completion and presentation during audits.
  • Respond to inquiries from various organizations and collaborate with internal and external stakeholders regarding credentialing and privileging matters.
  • Perform internal audits of files and assist with managed care credentialing audits.
  • Verify essential pre-employment credentials, including certifications, licenses, education, and other relevant qualifications.
  • Maintain confidentiality of all records and information while executing job responsibilities.
  • Develop and manage a schedule for audits across all programs.
  • Oversee data and document entry within credentialing software.
  • Generate monthly reports concerning staff credentialing.
  • Be prepared to travel to various COMHAR locations for credentialing activities as needed.
  • Perform additional duties as assigned.

Qualifications:

  • High School diploma or GED is required.
  • A minimum of 2 years of relevant credentialing experience in healthcare or human services is preferred.
  • Proficiency in Microsoft Office Suite (Word, Excel) and familiarity with HRIS systems.
  • Understanding of full cycle credentialing and re-credentialing processes.
  • Knowledge of Medicaid, Medicare, and Managed Care organizations.
  • Familiarity with clinical operations and procedures.
  • Skills in database management, including querying, reporting, and document generation.

COMHAR, Inc. is proud to be an equal opportunity employer. We maintain a drug-free workplace and do not discriminate in services or employment based on any protected class.



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