Credentialing Coordinator Position Available In Miami-Dade, Florida

Credentialing Coordinator Provider Network Solutions LLC Miami, FL Job Details Full-time $40,000 – $45,000 a year 1 day ago Qualifications Bilingual Customer service Mid-level Microsoft Office 1 year Associate’s degree Communication skills

Full Job Description Description:

Position Summary Supports the Contracting and Provider Servicing Department’s new and existing groups credentialing needs to achieve department goals, according to the Department’s Policies and Procedures. Coordinates network group submissions, such as, provider applications to internal departments and external customers (i.e., Health Plan partners, PCPs, Hospitals, and Network Specialty Providers). Duties and Responsibilities Reviews and processes Institutional, Specialty and Ancillary groups incoming and outgoing documentation, including contracts, credentialing applications, welcome letters, and all other related forms, according to the Department’s Policies and Procedures. Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame. Supports all Field Representatives to obtain credentialing and new Health Plan request documentation and manages new Institutional, Specialty and Ancillary groups, existing groups and/or additional Health plan requests. Answers incoming telephone inquiries from groups and assists with the resolution of issues/needs. A liaison in conjunction with all Contracting Specialists and Servicing Specialists for all Health Plans and affiliates for new groups and existing groups inquiries/submissions assigned by Manager or submitted through the Credentialing inbox. Assist with delegated credentialing and Network management audits. Attend credentialing committee meetings as requested by Manager. Configures system data loads for new Institutional, Specialty and Ancillary groups from new and existing business, and updates to groups credentialing status. Entries are made in proprietary system and TPA system. Liaison between Network and Health plans for weekly, monthly, and quarterly compliance Reports. Run GeoAccess reports on a quarterly basis and as needed. Cross train within department to support credentialing operations (providing back-up support for vacation/PTO) Participate in educational training as required. Special Projects as assigned or directed.

Requirements:

Knowledge Associate degree preferred or equivalent directly related experience. Minimum 1+ years’ experience in customer service or healthcare with exposure to problem resolution. Skills Excellent problem-solving skills. Intermediate Microsoft Office skills Works well individually and/or with a team setting. Deductive Reasoning Proficient in oral and written communication skills. Bilingual a plus.