Steward Health Care System

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Credentialing Coordinator

at Steward Health Care System

Posted: 11/27/2020
Job Status: Full Time
Job Reference #: 28000
Keywords:

Job Description

Location: Health Choice Management Co.
Posted Date: 5/15/2020

Position Purpose: Reporting to the Credentialing Manager, the Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Health Choice providers in alignment with State, Federal, and NCQA standards.

Responsibilities:

  • Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
  • Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes
  • Identify and communicate agenda items for Credentialing Committee to the Credentialing Manager
  • Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file
  • Promptly address incoming files for processing
  • Review and maintain all applications for accuracy and completeness
  • Accurately and efficiently data enter primary source verification data into the credentialing database
  • Input credentialing decisions and dates into the credentialing database
  • Generate and mail approval letters to participating providers
  • Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain
  • Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process
  • Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing
  • Maintain ongoing participation in cross-training activities
  • Provide recommendations and feedback regarding process improvements and/or standardization practices
  • Actively participate in staff meetings, team huddles, and one-on-one meetings
  • Engage in team building activities
  • Other duties as assigned

Education / Experience / Other Requirements

Education:

  • Associates degree in a related field (or equivalent combination of education and experience)

Years of Experience:

  • A minimum of two years of relevant work experience in a healthcare field, preferably within a credentialing/recredentialing environment and knowledge of national accreditation and/or regulatory standards

Specialized Knowledge:

  • Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred
  • Certified Provider Credentialing Specialist (CPCS) preferred

Skills & Abilities:

  • Ability to think critically
  • Strong attention to detail
  • Excellent organizational skills
  • Verbal and written communication skills
  • Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels
  • Maintains confidentiality according to policy
  • Effectively communicate with internal and external customers via telephone and email
  • Accurately receive information through oral communication
  • Accurately review data and figures both in hard copy and electronic formats
  • Utilize a computer (including but not limited to a mouse and keyboard) and telephone intermittently throughout entire shift, for periods of up to four (4) hours at a time
  • Accurately sort through data and think through issues in a timepressured environment
  • Focus on a specific event or activity for up to four (4) hours at a time without interruption
  • Maintain a calm and collected presence while addressing the concerns from an internal and external customer
  • Accurately learn and retain new information, knowledge and skills
  • Efficiently manage multiple tasks, with varying degrees of priority, at the same time

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!