Credentialing Coordinator I

2 weeks ago

Chandler, Arizona, United States Arizona Priority Care Full time
Job Title: Credentialing Coordinator I

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on delivering Whole-Person care to Senior and Medicaid populations through advanced value-based models. Our provider network comprises over 4,000 providers, including Primary Care, Specialty, Hospital System, and ancillary provider partnerships. We have operated in the Arizona market for more than 12 years and are based in Chandler, Arizona.

As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences, and reducing costs.

Job Summary:

The Credentialing Coordinator I is responsible for processing initial credentialing and recredentialing applications for practitioners in accordance with contracted health plans, regulatory bodies, and NCQA standards. This role involves verifying primary sources and the data entry component of the credentialing process.

Key Responsibilities:
  • Manage the credentialing department email by distributing to the appropriate folders.
  • Process incoming mail via USPS that includes new or returned mail.
  • Review and document EzCap load notifications from the Provider Database Specialist for new contracted practitioners.
  • Process practitioner applications within Morrissey database (MSOW) in accordance with the contracted health plan, regulatory bodies, and NCQA standards.
  • Enter current data into the MSOW database with a minimum of 10 files per week with a 95% accuracy rate.
  • Contact practitioner's office for additional information needed for completion of credentialing process.
  • Process expired primary source verification documents that include state licensure, Drug Enforcement Administration (DEA), Certificate of Insurance (COI), General Liability Insurance (COL), and accreditation/board certifications in a timely manner.
  • Manage the credentialing database in Morrissey by making the necessary changes to provider demographics.
  • Adds providers to CAQH for credentialing and remove when credentialing process is complete.
  • Provide exceptional, courteous, and professional phone customer service.
  • Assist practitioners as needed with the credentialing process including status.
  • Perform as necessary to accommodate to departmental change, workload, and emergences.
  • Maintain current knowledge of CMS and NCQA Standards, and AZPC Credentialing, Plan, policies and procedures.
  • Protect privacy for practitioners, to ensure information is kept confidential.
  • Demonstrate caring, empathy, patience, respect, and compassion for all team members.
  • Demonstrate honesty and integrity in everyday activities.
Requirements:
  • High school diploma or GED required.
  • Minimum of 1-year administrative healthcare-related experience – Required.
  • Minimum of 2 years of credentialing/re-credentialing experience preferred.
  • Knowledge of Morrissey credentialing software system preferred.
  • Working knowledge of computer applications, such as Microsoft Office (Word and Excel)
  • Excellent written and verbal communication skills.
  • Demonstrate ability to be detail-oriented and multi-task effectively.

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