Non-Exempt Credentialing Support Coordinator

2 weeks ago


Long Beach, California, United States HealthCHEC Full time

Position Title: Credentialing Coordinator

Work Arrangement: Remote

Employment Type: Full-Time

About HealthCHEC

HealthCHEC is a dedicated organization focused on addressing the significant challenges faced by older adults in the United States. As a leader in the healthcare sector, we are committed to enhancing the well-being and independence of seniors, leveraging over 40 years of expertise in senior healthcare. Our team comprises skilled professionals passionate about supporting older adults while innovating healthcare solutions. We provide comprehensive training and access to advanced tools, fostering professional development and growth opportunities for our employees. At HealthCHEC, we recognize our team members as experts and reward their contributions.

Job Overview:

The Credentialing Coordinator plays a vital role in managing and facilitating the reporting requirements by gathering, monitoring, and reviewing submissions mandated by CMS. This position involves assisting with administrative tasks related to practitioner credentialing, organizing and maintaining accurate records, and ensuring timely updates on practitioner certifications. The Coordinator will develop and sustain positive relationships with providers and groups, serving as a knowledgeable resource for inquiries and compliance methodologies. This role champions adherence to corporate audit policies and provides support for escalated issues as necessary.

Key Responsibilities:

  • Assist Network Compliance Credentialing Auditors with the processing of initial and re-credentialing applications.
  • Screen applications and supporting documentation to verify eligibility, collecting data from relevant sources.
  • Identify discrepancies and conduct follow-ups, presenting applications to the Credentialing Committee.
  • Respond to credentialing inquiries and ensure compliance with applicable laws and regulations.
  • Educate delegated entities on the submission of complete and accurate data according to CMS and NCQA specifications.
  • Act as the primary contact for delegates regarding CMS-required credentialing submissions.
  • Support initial, annual, and focus credentialing delegation audits.
  • Issue and monitor Corrective Action Plans for groups that fail to submit required documentation accurately and on time.
  • Facilitate the timely collection of required delegate submissions for the Delegation Oversight Unit.
  • Maintain confidentiality and protect the privacy of provider networks, customers, and members.
  • Adhere to quality, compliance, and regulatory standards to achieve organizational goals.

Qualifications:
  • Associate's Degree or equivalent experience.
  • Minimum of 3 years of experience in a healthcare or managed care setting.
  • Proficient in data entry and MS Office.
  • Strong critical thinking and decision-making skills.
  • Excellent verbal and written communication abilities.
  • Strong organizational and interpersonal skills.
  • Demonstrated customer service proficiency.
  • Ability to multitask and work independently in a fast-paced environment.

Benefits:
  • Competitive salary range.
  • Annual employee bonus program.
  • Comprehensive wellness initiatives.
  • Generous paid time off and holidays.
  • 401(k) Retirement Savings Plan with employer matching.
  • Employee recognition programs.
  • Tuition reimbursement opportunities.
  • Work-life balance support.

At HealthCHEC, we are committed to fostering an inclusive workforce that reflects the diversity of our community. We are an Equal Employment Opportunity and Affirmative Action employer, ensuring that all qualified applicants receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, or veteran status. A background check is required.

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