Credentialing Coordinator

Job Summary:

The Credentialing Specialist is responsible for the timely and accurate processing of credentialing applications and rosters with funders, insurance companies, other payers, and regulatory agencies. The role is a key part of the process to ensure that the company is appropriately reimbursed for the services provided by its clinical staff.

Essential Functions:

1. Credentialing Process: Collect, review, and verify credentials for healthcare providers, including licenses, certifications, education.
2. Database Management: Maintain and update credentialing databases and files for all healthcare providers and ensure all required documents are complete and up to date.
3. Compliance: Ensure adherence to all applicable laws, regulations, and industry standards (e.g., NCQA, CMS, etc.) related to credentialing.
4. Reporting: Generate and maintain reports related to credentialing status and compliance and communicate any issues or discrepancies to management.
5. Insurance & Network Enrollment: Assist with the enrollment of providers and group facility into insurance networks and maintain active status with payer organizations.
6. Provider Communication: Act as a liaison between healthcare providers, insurance companies, and internal departments to resolve credentialing issues or questions.
7. Audit Support: Participate in internal and external audits of credentialing files, ensuring accurate and timely completion of necessary documentation.
8. Continuous Improvement: Stay informed of changes in regulatory requirements and best practices to ensure the credentialing process remains efficient and compliant.
9. Safeguard the dignity and respect of individuals we support and ensure they are treated in accordance with Advocates’ Human Rights policies
10. Adhere to all principles related to the Advocates Way
11. Promote cultural diversity, inclusion, and equity
12. Perform all duties in accordance with the agency’s policies and procedures.

Please note: The essential functions listed in this section are not limited only to the tasks listed and may include other duties as assigned.

Qualification/Education/Experience:

1. Associate’s degree or Bachelor’s degree in healthcare administration, business, or in lieu of degree, at five years or of experience in a similar role. Minimum of two years of experience in credentialing or healthcare administration preferred.
2. High energy level, superior interpersonal skills, and ability to function in a team atmosphere, Strong attention to detail and organizational skills, ability to manage multiple tasks and deadlines in a fast-paced environment Results oriented with the ability to balance other business considerations.
3. Strong system skills with average to above average use of excel.