What are the responsibilities and job description for the Coordinator, Credentialing position at Independent Living Systems?
ABOUT US
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Credentialing Coordinator will be responsible for all aspects of the credentialing process for the health care providers. The representative will process applications, verify information, research application details, and assure processes are in accordance with State regulations. The representative will provide consistent, accurate, documented verification of the information provided by the applicant and maintenance of the highly confidential credentialing related files, enhancing the organization’s ability to provide professional services.
Essential Functions
- Responsible for getting information-Observing, receiving, and otherwise obtaining information from all relevant sources.
- Credentialing Representative will assist with audits and provide feedback to reduce errors and improve processes and performance.
- Process provider applications and performs primary sources verification in accordance with national accreditation standards, regulatory requirements and has through knowledge of all aspects of credentialing.
- Responsible for monitoring credentialing information regarding issues relating to the credentialing files.
- Completes the process of primary verification when needed.
- Monitors websites and software program when needed to oversee the information is running smoothly and effectively.
- Conducts daily/weekly reports on closing of files, expiration dates, current licensure, DEA, and malpractice.
Education and Experience
• High School diploma or equivalent; bachelor’s degree preferred.
• Three (3) years of credentialing experience
• Undergraduate degree or 3 years of applicable experience in medical credentialing environment preferred
Required Skills
• Knowledge of provider credentialing criteria and processes in accordance with NCQA and JCAHO standards NPDB guidelines licensing regulations.
• Certified Provider Credentialing Specialist (CPCS) or certified Medical Staff Coordinator (CMCS) by the National Association of Medical Staff Services (NAMSS) preferred.
• Maintains continuing education activities in the filed regarding medical, administrative ethical and legal requirements of credentialing.
• A thorough knowledge of all aspects of the credentialing process to include standards, policies and procedures, as well as legal issues involved preferred.
EEO STATEMENT
Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
