What are the responsibilities and job description for the Credentialing Coordinator position at Viva Health?
Credentialing Coordinator
Location: Birmingham, AL
Work Schedule: Mostly Remote - after a 2-4 week onsite training period at our downtown Birmingham office, this position can transition to work mostly remote, with occasional onsite days. The successful candidate must reside within a reasonable travel distance of Birmingham.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Healthcare Reimbursement Account
- Paid Parental Leave
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
- Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Credentialing Coordinator is responsible for credentialing and re-credentialing practitioners, ancillary service providers and allied health professionals to ensure their qualification to participate in VIVA HEALTH’S provider network. The Credentialing Coordinator will serve a primary role in receiving and incorporating provider data appropriately into the provider set-up workflow process. This position will act as a resource for provider data integrity, provider file management and network development.
Key Responsibilities
- Receive, interpret and incorporate Council for Affordable Quality Healthcare (CAQH) provider data into the credentialing, re-credentialing, and provider data auditing process.
- Use CAQH data and credentialing software findings to make credentialing decisions regarding providers.
- Analyze trends in monthly credentialing data to forecast workload for CAQH.
- Communicate with internal departments to ensure quality assurance findings related to providers are reviewed and acted upon accordingly.
REQUIRED QUALIFICATIONS:
- Bachelor's Degree or equivalent experience in credentialing
- 3 years of experience in credentialing
- Ability to analyze and solve problems related to credentialing of providers and facilities
- Proficient in manipulation of data to report statistical information to several of departments
- Ability to work independently, research and resolve processing issues in a timely manner with little to no supervision
- Organized, detail oriented, and skilled at multi-tasking
- Demonstrate excellent customer service skills through written and verbal communication
- Proficient in the Microsoft Office suite of products
- Knowledge of credentialing software, CAQH, CMS, NCQA guidelines, and JCAHO regulations
