Job Description

Job Description

Job Description

Position Summary
The Credentialing Coordinator role will be responsible for ensuring all providers have the necessary requirements and are approved to participate in the application client health plans. S/He will maintain strong cross-departmental relationships with Recruiting, Production, and Education. This role will report to our Manager of Credentialing.

• Review and screen initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local, and NCQA regulations, guidelines, policies, and standards.
• Conduct primary source verification, collect and validate documents to ensure accuracy of all credentialing elements; assess completeness of information and qualifications relative to credentialing standards and Signify Health criteria, while maintaining the confidentiality of all protected health information that may be accessed.
• Identify, analyze, and resolve extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact the ability to credential and enroll practitioners; discover and convey problems to Credentialing Manager/Supervisor/Director.
• Monitor files to ensure completeness and accuracy; review all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepare and provide information to internal and external customers as appropriate.
• Enter, update, and maintain data from provider applications into the credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses and in accordance with internal policies and procedures.
• Prepare, issue, electronically track, and follow up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Communicate clearly with providers, internal/external clients, and all Signify Health staff as needed to provide timely responses upon request on day-to-day credentialing issues as they arise.
• Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest developments to enhance understanding of various regulations and legislation of the healthcare industry.
• Assist with special projects on an as-needed basis.

Qualifications

• Successful work experience in a credentialing role.
• NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) or within 2 years of eligibility to certify (Preferred).
• CAQH Experience (Preferred).
• MD Staff Experience (Preferred).
• Google Suites Experience (Preferred).

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