Credentialing Coordinator

At eTeam Inc, we are seeking a highly skilled Credentialing Coordinator to join our team. As a Credentialing Coordinator, you will play a critical role in ensuring the timely and accurate processing of all providers, including nurse practitioners, physician assistants, and physicians.

Key Responsibilities:

• Initial credentialing and re-credentialing of medical professionals in a compliant and timely manner
• Monitoring expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA, and URAC credentialing standards
• Timely and accurate processing of all provider applications
• Managing Epic access for providers with out-of-compliance licensure and/or board certification
• Conducting sanctions and compliance monitoring, and alerting leadership to any undisclosed negative findings
• Processing malpractice insurance verification requests according to internal policies
• Maintaining provider and physician SharePoint sites, and communicating provider status with leadership and internal teams
• Submitting system access requests upon credentialing approvals/clinic eligibility
• Supporting the payer enrollment team as needed to resolve any payer claim issues
• Monitoring provider and clinic change/termination reports, and updating the database accordingly
• Processing name changes according to client policies and procedures
• Daily maintenance of provider credentialing grids, with notification to appropriate teams
• Reviewing and distributing all incoming mail as needed
• Supporting payer audits in accordance with client, Joint Commission, and NCQA requirements
• Maintaining provider files with the most current information/documentation
• Notifying system analysts and leadership of any system and state agency interruptions/updates/password changes
• Making recommendations for process improvement and system efficiencies
• Attending and engaging 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