Credentialing Coordinator

7 days ago

Chicago, Illinois, United States Zing Health Holdings Full time

COMPANY OVERVIEW

Zing Health is a tech-enabled
insurance company making Medicare Advantage the best it can be for those
65-and-over. Zing Health has a community-based approach that recognizes the
importance of the social determinants of health in keeping individuals and
communities healthy. Zing Health aims to return the physician and the member to
the center of the health care equation. Members receive individualized assistance
to make their transition to Zing Health as easy as possible. Zing Health offers
members the ability to personalize their plans, access to facilities designed
to help them better meet their healthcare needs and a dedicated care team. For
more information on Zing Health, visit

SUMMARY DESCRIPTION:

Coordinate the process of
gathering all credentialing materials.  Assist
with completion of credentialing new and established health care
providers.  Maintains and updates
provider credentialing database.  Ability
to build relationships with all levels of personnel within the Zing Health
Network organization and external provider networks. 

ESSENTIAL FUNCTIONS: 

  • Assures credentialing files are complete
    with the necessary documentation
  • Review
    credentialing applications, apply policy and criteria, perform primary source
    verification, process files and forward completed files to appropriate area for
    processing
  • Monitors and conducts appropriate
    follow-up regarding supportive credentialing documentation including current
    licensure, malpractice status and history, board certification, and related
    functions according to established time frames.
  • Review monthly regulatory and disciplinary action
    reports issued by State licensure bodies and the Office of Inspector General
    Medicaid and Medicare Sanctions reports.
  • Understand credentialing requirements per Zing Health
    policies, as well as state and federal requirements.
  • Audit provider directories.
  • Produce regularly
    scheduled network and ad hoc reports.
  • Attend and
    provide support for Credentialing Committee meetings.
  • Demonstrate consistent ability to multi-task,
    prioritize and perform independently to execute assigned tasks.
  • Special projects as assigned or directed.


QUALIFICATIONS
AND REQUIREMENTS:

 JOB REQUIREMENTS:

  • High School Diploma
  • Two (2)+ years of previous
    managed care insurance or physician credentialing experience required
  • Ability to navigate complex
    health plan enterprise systems.
  • Ability to analyze data for
    identifying trends, and variance from goals. 
  • Ability to comprehend JCAHO
    standards and state and federal laws related to credentialing.
  • Ability to work autonomously.
  • Efficient and concise
    communication skills.
  • Attention to detail, organized
    and have excellent time management capabilities
  • Microsoft Suite knowledge a
    must.

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