What are the responsibilities and job description for the Credentialing Coordinator position at Group Health Cooperative of Eau Claire?
Position Purpose
Coordinates and oversees the delegated credentialing process for all practitioners and providers within the network. Serves as a back up for the non-delegated credentialing process for all practitioners and providers in the network.
Essential Position Functions
Coordinates and oversees the delegated credentialing process for all practitioners and providers within the network. Serves as a back up for the non-delegated credentialing process for all practitioners and providers in the network.
Essential Position Functions
- Oversee and administer the delegated credentialing program.
- Communicate effectively with outside provider, CAQH, regarding provider credentialing and recredentialing needs.
- Ensure all providers are credentialed and re-credentialed on a timely basis.
- Maintain credentialing databases.
- Data collection, entry and verification for all provider directory data.
- Generate credentialing reports.
- Assist with gathering information for credentialing committee.
- Apply federal and state guidelines that address credentialing and re-credentialing processes.
- Follow NCQA credentialing guidelines.
- Communicate with providers and practitioners with exceptional customer service skills to fulfill the credentialing requirements.
- Assist with provider mailings.
- Assist with annual audit functions for delegated providers
- Ensure delegated providers are providing reports as required.
- Communicate effectively with Provider Relations and Credentialing team.
- Other job-related duties as may be necessary to carry out the responsibilities of this position.
Minimum Requirements of the Position
- High school graduate or equivalent.
- Knowledge of medical terminology and managed health care is desirable.
- High level of proficiency in Microsoft Access, Word, Excel and Internet navigation.
- Excellent interpersonal, communication, writing, organizational, project management, and math skills.
- Ability to work in a fast-paced work environment and meet deadlines.
- Knowledge of medical terminology is beneficial.
Group Health Cooperative of Eau Claire considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
Standard Text to Copy into Websites for GHC/KMTSJ Positions: This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
Standard Text to Copy into Websites for GHC/KMTSJ Positions: This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
