Job Title:

Provider Credentialing Coordinator Job Summary:

The Credentialing Coordinator will process applications for health insurance plans with whom we are contracted and in-network with, ensuring the supporting documentation is complete. In addition the Credentialing Coordinator will verify that each individual provider has a list of approved payers. In addition to processing applications, the Credentialing Coordinator will track licenses and malpractice certificates and board certification expirations to ensure providers fulfill their renewal requirements. This role is essential to preserving the confidentiality and safety of our patients, so all federal and state regulations as well as internal policies must be followed.

Duties & Responsibilities:

• Participate in the development and implementation of credentialing processes and procedures.
• Develops and maintains current, accurate, and confidential credential files for each credentialed/privileged provider. Handles and assures the confidentiality of sensitive information about providers including peer review, performance improvement data, health matters, and medico-legal issues.
• Collecting and maintaining an accurate practitioner database and analyzing verifications.
• Establishing and maintaining a system for timely processing of credentialing and re-credentialing files.
• Applies general guidelines in determining whether provider meets criteria and documents deficiencies.
• Monitor work to ensure that applications are processed within a 30 day turnaround time.
• Modifying and designing reports and queries to demonstrate the effectiveness of the credentialing/re-credentialing process.
• Implement processes around credentialing/re-credentialing applications accurately and promptly in accordance with policies and procedures.
• Obtains and validates CMS and State Surveys, State Licenses, Medicare Certifications, Medicaid Certifications, and other documentation as necessary.
• Assemble all verified information and prepare files for presentation to the Medical Director or designee.
• Maintain communications with provider offices or Office Coordinators to promote relationships imperative to process. Required Skills & Abilities The requirements listed below are representative of the knowledge, skill, and/or ability required.
• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Proven knowledge of health care and credentialing industry.
• Strong understanding of credentialing regulatory and accreditation requirements.
• Proficient in Microsoft Office Suite or related software.
• Proficient in Electronic Medical Records, preferably eClinicalWorks.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Good understanding of clerical procedures and systems such as recordkeeping and filing.
• Ability to prioritize tasks.
• Ability to function effectively function well in a high-paced and at times stressful environment.
• Ability to establish and maintain effective working relationships.
• Ability to work independently.
• Ability to write effective and professional business correspondence.
• Ability to solve practical problems and deal with a variety of variables.
• Understanding of acceptable medical office processes and procedures.
• Basic understanding of how to operate standard business equipment.
• This position requires the ability to multi ‐ task, meet deadlines, make good decisions, and portray a professional and positive attitude. .Ability to manage Medicare, Medicaid and Commercial Insurance enrollment. .Ability to manage CAQH,NPPES,PECOS and payer portals Education and /Experience
• High school Diploma or equivalent required.
• At least two years of progressively responsible medical office clerical experience required.
• At least one year-three years of experience as a credentialing coordinator or equivalent.
• Experience with eClinicalWorks strongly preferred. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is frequently required to walk, sit; use hands to finger, handle, or feel and talk or hear.
• The employee is occasionally required to stand.
• The employee may occasionally lift and/or move up to 25 lbs. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• While performing the duties of this position, the employee performs tasks in a temperature controlled office environment under normal office conditions.
• The noise level in the work environment is usually moderate.
• The work environment involves minimal exposure to hazards or physical risks, which require following basic safety precautions.

Equal Opportunity Employer:

Midway Specialty Care Center is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, sex (including pregnancy, childbirth) gender identity, sexual orientation, national origin, age, disability, veteran status, or any protected status under law.

MIDWAY SPECIALTY CARE IS A DRUG FREE WORKPLACE.

Job Type:

Full-time Pay:

$16.00 - $18.00 per hour

Benefits:

401(k) Dental insurance Employee assistance program Health insurance Life insurance Paid time off Tuition reimbursement Vision insurance Application Question(s): How many years of experience do you have working with medical insurance and hospital privileges for medical providers?

Experience:

Credentialing Coordination:

1 year (Required)

Work Location:

In person