Credentialing Coordinator

Position Summary:

Autism Learning Partners’ (ALP) Credentialing Department functions as a service department designed to support ALPs’ network of providers and operational counterparts. The Credentialing Administrator will be working out of the Credentialing Department with a national team of clinical colleagues as well as support staff and will report to both the Credentialing Manager and Director of Contracting and Credentialing. The Credentialing Administrator role will manage assigned credentialing regions at a 85% satisfactory rate, attain fully credentialed statuses and achieve 100% of application completion within the 7-day deadline (earlier timeline may be implemented for process changes).

Job Responsibilities:

• Ensure provider application eligibility by analyzing provider credentials, accompanying documents, and requesting/correcting documents as needed to fulfill application process.
• Complete/populate all applications using Intellicred database, review applications for accuracy and completeness for all new hires within 7-day deadline or earlier timeline. Applications are expected to be completed at a 100% satisfactory level within the deadline.
• Maintain follow-up and status reports to completion of eventual 85% approval statuses for each payor.
• Record status and provider progress in Daily Matrix, and Approval Matrix with notes. Respond to issues that require additional investigation and evaluation regarding regions or delegated inquiries.
• Monitor documentation renewal/expiration dates to provider credentials, applications, demographic updates, and more.
• Maintain CAQH profiles, NPIs, and Intellicred profiles for each provider in assigned region.
• Complete all assigned rosters in a timely manner.
• Collaborate with Insurance and Payor Reps, Providers, Department Staff, and Company Staff to obtain needed documents and information to support Department-wide in efforts to streamline our services and problem solve when required.
• Other duties as assigned
• Contribute to team effort by accomplishing related results as needed.

Required Qualifications

• Bachelor’s Degree, or equivalent education/work experience, preferred.
• 2-3 years of experience working in health care provider operations, or equivalent experience with credentialing, claims, and provider data management.
• Ability to prioritize tasks and meet deadlines with minimal supervision.
• Strong analytic, quantitative, problem-solving, critical thinking, and decision-making skills.
• Strong verbal and written communication skills.
• Strong understanding of National Provider Identifier (NPI), and provider set up requirements such as excluded and optout provider settings.
• Accurate data entry skills and proficiency in MS Word, Excel, and Outlook.

Experience

• 2-3 years of experience working in health care provider operations, or equivalent experience with credentialing, claims, and provider data management.

Physical Demands/Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be available to enable individuals with disabilities to perform the essential functions.

Physical Demands/Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be available to enable individuals with disabilities to perform the essential functions.

Physical Demands:
Stand/Walk: None
Sit: Constantly 2/3 or more
Talk or Hear: Constantly 2/3 or more
Push or Pull: None
Crouch or Crawl: None
Reach with hands and arms: None
Lift up to 15lbs, 25lbs or 50lbs: None

Work Environment:
Noise Level: Moderate

Job Duties Disclaimer Statement
This position description does not imply that these are the only duties to be performed by the employee. Employee will be required to follow all other job-related instructions and to perform all other job-related duties directed by their supervisor.

Autism Learning Partners supports a diverse workforce and is an Equal Opportunity Employer.

Job Type: Full-time

Pay: $21.00 - $23.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• health care provider operations: 1 year (Preferred)
• Credentialing: 1 year (Preferred)

Work Location: One location