What are the responsibilities and job description for the CREDENTIALING COORDINATOR position at Shenandoah Community Health?
Shenandoah Community Health (SCH) is here to bridge the gap in healthcare access. As a Federally Qualified Health Center, we tackle the challenges of cost, transportation, and language barriers to ensure everyone in our community receives the care they need. We offer a comprehensive range of services, including primary care for adults and children, women's health, behavioral health, and oral health. Plus, we provide additional support services such as on-site pharmacy, labs, and radiology. Working at SCH isn't just a job; it's a chance to make a real difference in the lives of your neighbors. Join our team and become part of the solution! Visit our website at Shenandoah Community Health to learn more.
Job Summary :
Shenandoah Community Health is recruiting an experienced Credentialing Coordinator. The coordinator will be responsible for credentialing new and established health care providers, provider enrollment with payors, maintenance of information to include in application completion, follow up, data collection, data entry, and document review. The Credentialing Coordinator facilitates all aspects of credentialing, including initial appointment, reappointment, expiring records, as well as clinical privileging for practitioners as outlined policies, or related documents. Ideal candidate will have the ability to work independently; and to prioritize and implement multiple projects.
Role & Responsibilities :
- Process initial and reappointment credentialing applications, including verifying healthcare provider information and licensing, National Practitioner Database (NPDB) and other required documentation ensuring that all regulatory requirements are met
- Maintains a current and accurate database of credentialing information.
- Assures compliance with regulatory requirements and accrediting body standards and policies and maintains current knowledge
- Communicates status of application to practitioners and all interested parties on a regular basis
- Manages, supports and maintains the Network Insurance Credentialing process for employed practitioners
- Completes audit updates on Network Insurance files
- Reviews Privilege request forms for accuracy and provides criteria as appropriate
- Assist with the gathering of information required to complete credentialing and re-credentialing activities for our contracted / employed providers
- Will complete and review all applications to ensure accuracy prior to submission
- File, maintain and update pertinent documents in credentialing files / software / database
- Will initiate and maintain payor enrollment
- Will initiate support facility credentialing of new medical facilities and acquisition of new locations
- Track provider certifications, licensure expiration dates and other expirable documentation, ensuring that all healthcare providers maintain current credentials and are in compliance with regulatory standards
- Establish and maintain data entry in Credentialing for Affordable Quality Healthcare (CAQH)
- Support provider enrollment with Medicare, Medicaid, and commercial insurances Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances.
- Supports the Peer Review process in collaboration with Chief Medical Officer.
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