Credentialing Coordinator

The Credentialing Coordinator will perform credentialing and recredentialing related functions for providers with facilities, health care systems, and/or managed care companies as needed. Credentialing functions include but are not limited to obtaining/tracking provider credentials, processing facility applications, performing primary source verifications, and assist with enrolling providers with payors in accordance with internal policies and procedures, client health plan contracts and applicable state/federal requirements.

Duties and Responsibilities

• Participate in the provider application/reapplication process by sending, receiving, and analyzing provider documents and data import to determine completeness in preparation for facility applications and payor enrollment.
• Participate in gathering, verification and evaluation of highly confidential and sensitive health care practitioner credentials consistent with company procedures and accreditation standards.
• Participate in enrolling providers with payors to include Medicare, Medicaid and state/federal commercial health plans and follow up as required until process complete.
• Track expiring documents, collect updated documents from the provider before the expiration, store in secure filing system and distribute as required.
• Participate in the update of CAQH with provider information.
• Direct and consistent communication with providers to obtain current credential documentation.
• Respond to provider, facility, payor health plans and internal inquiries in a timely manner.
• Work with credentialing partners to ensure all payor enrollments are complete within company anticipated timelines.
• Utilize and update credentialing software with provider data points.
• Submit credentialing documents to facilities and third-party insurers efficiently and accurately.
• Securely store provider information in electronic document library
• Update credentialing software with provider data points
• Competently utilize Microsoft Excel and credentialing software to maintain provider information and to track expiring documents.
• Track and log status on assigned credentialing projects and open items to completion.
• Adheres to credentialing policies and operating procedures.
• Participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
• Contributes to positive culture.
• Any and all other duties as assigned

Education and experience required:

• Detail oriented
• Critical thinking skills- ability to work independently with some assistance and ability to follow set procedures
• Highly organized and able to maintain multiple tasks at a time
• Time management skills
• Strong work ethic
• Available to work 40 hours a week
• Ability to use computer software systems including by not limited to Word, Excel and credentialing software
• Healthcare/dental experience preferred
• Must be able to pass a drug screen and background screen

CERTIFICATIONS / LICENSURES / CREDENTIALS: None

SUPERVISORY RESPONSIBILITIES: None

PHYSICAL DEMANDS:

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires sitting for extensive periods of time. Occasional lifting and carrying items weighing up to twenty (20) pounds may be required. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT:

The work environment characteristics described are representative of those an employee encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public.

Job Type: Full-time

Pay: $18.93 - $21.00 per hour

Expected hours: 40 per week

Benefits:

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

Schedule:

• Monday to Friday

Ability to Commute:

• Baton Rouge, LA 70809 (Required)

Ability to Relocate:

• Baton Rouge, LA 70809: Relocate before starting work (Required)

Work Location: In person

Salary : $19 - $21