Delegated Credentialing Coordinator
Mindful Health Solutions
Atlanta, GA
Full-time
Health Care Provider
Posted on May 25, 2022
Position Overview:
We are looking for a Delegated Credentialing Coordinator responsible for processing credentialing and re-credentialing applications and/or enrollments of health care providers. This role will have direct responsibility for the delivery of a quality candidate and onboarding experience that support the company’s mission and values.
Responsibilities:
- Reviews applications, prepares verification letters and maintains database
- Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and re-credentialing applications
- Must have ability to work with health care acronyms, able to differentiate between provider titles, download the providers applications using the Internet
- Identify any issues or trends and bring them to the attention of management team
- Assist with coordination of audit activity for certifications (NCQA etc.) and third-party audits (payors, self-insureds, carriers, etc.) for both initial and concurrent audits for delegated credentialing services; also includes monitoring program compliance with contractual terms and effective enforcement of operational provisions
- Build knowledge base for payer requirements and forms.
- Tracks license, and professional liability expirations for appointed providers.
- Completes provider credentialing and re-credentialing applications for escalated cases; monitors applications and follows-up as needed.
- Maintains appointment files and information in credentialing.
- Provides excellence in customer service for internal and external customers when handling communications, whether oral or written.
- Other duties as assigned
Requirements:
- Minimum of 2 years credentialing experience
- Delegated credentialing experience and knowledge on the payor side or provider side required.
- Good understanding of the credentialing process
- Capable of successfully completing credentialing applications with limited supervision
- Ability to maintain confidentiality, work with deadlines and manage multiple priorities.
- General understanding of medical staff policies, regulations, and bylaws and the legal environment within which they operate.
- Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products.
- Detail Oriented, organized, and able to multi-task on critical workflows
- Tech savvy and able to work in virtual environments
- Ability to communicate effectively, both orally and in writing