Provider Credentialing Coordinator

2 weeks ago

Industry, California, United States Innovative Management Systems Incorporated Full time

Position: Provider Credentialing Coordinator

-Hybrid: Remote & In-office (as needed)

This role reports to the Director of Provider Services and is accountable for the comprehensive credentialing process of Providers and Facilities. Candidates must possess experience in the credentialing of various healthcare facilities including Hospitals, Skilled Nursing Facilities (SNF), Home Health, and Radiology. The Coordinator will collaborate closely with new client implementations and assist in the transition of Credentialing files for clients moving between management service organizations. Strong organizational skills, meticulous attention to detail, and the ability to identify issues and propose solutions are essential for this position. The role will involve thorough audits of previously approved files to ensure that system data aligns with documentation and to identify errors that could affect Health Plan audits. The Coordinator will oversee the extraction of Provider Rosters, ensure compliance with re-credentialing timelines, and maintain CAQH accounts. Additionally, the Coordinator will prepare files for pre-delegation and annual audits, monitor Providers and entities, and work in conjunction with Quality Assurance, which may require some travel for Facility Site Reviews.

Key Responsibilities Include:

  • Conducting audits of Credentialing files for oversight and new client implementation.
  • Organizing documentation and ensuring accurate entry of Provider and Facility data into the database while validating all essential elements required for Credentialing and Provider Rosters.
  • Establishing workflows for the exchange of files between client auditors and CAQH.
  • Reviewing initial documentation and applications to identify potential issues and following up with healthcare providers to obtain missing information or additional details as necessary.
  • Performing primary source verifications to confirm proper licensing, training, and certification as mandated by state and federal regulations, while monitoring Providers for adverse events and ensuring credentials and privileges are current.
  • Reviewing hospital privileging, generating quality reports, and assessing reappointment applications.
  • Generating reports for various departments, assisting in identifying network deficiencies, and periodically auditing files to ensure they are current and ready for audits.
  • Building and maintaining positive working relationships with internal and external stakeholders.
  • Preparing and facilitating Credentialing Committees.
  • Participating in staff meetings and ongoing education, recommending new approaches, opportunities for automation and data migration, reviewing policies and procedures, and suggesting continuous improvements in departmental efficiency and service delivery.
  • Traveling to providers' offices as required for credentialing purposes.
  • Troubleshooting and making necessary phone calls related to Credentialing and/or Provider Services.
  • Other duties and projects as assigned.

Position Details

  • Full Time, Benefits Eligible
  • Non-Exempt
  • Hybrid: Remote & In-Office (as needed)

Compensation

  • $25 - $31 per hour or Competitive Compensation

Innovative Management Systems Incorporated offers competitive compensation and is an equal opportunity employer committed to diversity in our workforce.

About Our Company

At Innovative Management Systems Incorporated, we are seeking highly motivated and resourceful individuals to join our expanding start-up. Our mission is to innovate the healthcare sector by providing management and consulting services to healthcare entities, including facilities, medical groups, providers, and suppliers. With our extensive experience and comprehensive knowledge of the healthcare industry, our team is dedicated to delivering quality services and customer care to our clients and their Medicare beneficiaries. By joining IMS, you will gain valuable insights into the managed care industry and contribute to the professional growth of our company. We encourage you to take initiative and ownership of your projects to make a meaningful impact.

Requirements:

Education

  • Associate degree or equivalent experience.
  • Bachelor's Degree preferred, and/or equivalent experience in healthcare administration, management service organization, health plan, and/or IPA.

Certifications/Licenses

  • Active and Valid Driver's License and unexpired car insurance.
  • Certified Provider Credentialing Specialist certification (CPCS) by National Committee for Quality Assurance (NCQA), preferred.

Experience

  • 3-5 years in healthcare administration, management service organization, health plan, and/or IPA.
  • Facilities credentialing experience, required.

Knowledge/Skills/Abilities/Other Attributes

  • Excellent communication skills.
  • Accurate data entry and proficient computer skills.
  • Quick learner with the ability to adapt to changing priorities.
  • Strong organizational skills.
  • Knowledge of credentialing and re-credentialing processes.
  • Familiarity with facilities credentialing processes.
  • Ability to interact effectively with physicians, contractors, and all levels of management.
  • Commitment to maintaining strict confidentiality.
  • Understanding of federal and state laws and compliance regulations, such as HIPAA.
  • Exceptional customer service and multitasking abilities.
  • Willingness to travel to various office locations as needed.

* Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.

Compensation details: $25 - $31 Hourly Wage

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