Managed Care Coordinator

1 month ago


Tallahassee, Florida, United States Orthopaedic Solutions Management Full time
Job Summary

We are seeking a highly organized and detail-oriented Managed Care Coordinator to join our team at Orthopaedic Solutions Management. The successful candidate will be responsible for implementing initial credentialing and re-credentialing functions for employed and contracted practitioners, ensuring timely and accurate practitioner insurance plan participation status, and maintaining data entry and periodically revising practitioner data in the Verity Stream credentialing database.

Key Responsibilities
  • Implement initial credentialing and re-credentialing functions for employed and contracted practitioners, including obtaining Medicare, Medicaid, and NPI provider numbers utilizing the PECOS, Medicaid, Availity, and NPPES websites.
  • Prepare Credentialing files for FOI Credentialing Committee, completing all required primary source verifications.
  • Maintain timely and accurate practitioner insurance plan participation status in Athena.
  • Process applications for facility appointment and reappointment of privileges.
  • Review practitioner applications for completion and accuracy, ensuring appropriate follow-up, and monitor and report on the credentialing progress of each practitioner in Verity Stream credentialing software program.
  • Compile and maintain timely and accurate data entry and periodically revise practitioner data in the Verity Stream credentialing database, maintaining practitioner electronic data files on the Managed Care L: Drive, and use the CAQH system to submit practitioner data as required by some health plans to credential individual practitioners.
  • Monitor expiring licensure, DEA, board, and professional certifications and other expirable documents with practitioners, assisting practitioners with timely renewal as appropriate and escalating to Manager as appropriate.
  • Maintain practitioner CME information, uploading into the CEBroker database.
  • Provide contracted managed care plans with issue resolution.
  • Keep Manager/Lead informed of potential credentialing or enrollment issues.
  • All other duties assigned.


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