Credentialing Coordinator

Job Description The Credentialing Coordinator is responsible for the collection, review and analysis of information that is obtained to credential and recredential physicians and other health care providers.
The Coordinator presents the information to the Credentialing Committee, which will review the information and determine if the providers should become part of the network of physicians and provide services to the members.
In addition, the Credentialing Coordinator is responsible for entering and auditing various lists to ensure that providers are properly displayed on the provider directory.
Essential Duties and Responsibilities1.
Initiate the collection of data for credentialing and ensure that credentialing and recredentialing are conducted in accordance with internal policies and procedures and that internal policies and procedures are in compliance with NCQA requirements.
Coordinate the credentialing/recredentialing process and acts as liaison for delegated credentialing relationships.
Process all Issue files, follows Non-Responder process according to all process steps and within required deadlines and ensure all files are complete and ready for Committee.
Maintain thorough understanding/knowledge of the NCQA credentialing standards and how they relate to the credentialing/recredentialing processes.
Analyze Issue provider files for completeness, accuracy, consistency, gaps in time, lack of hospital admitting privileges, low insurance coverage, relevant references, etc.
Identify substantive issues and initiate further data collection as needed, from internal and external sources in order to bring files to closure.
Maintain thorough understanding/knowledge of the policies including rules, regulations, and legal issues relating to the credentialing/recredentialing processes.
Understand end-to-end process flows.
Familiar with all systems that support Credentialing processes.
Effectively interface with other Credential Coordinators, Provider Development, Credentialing Committee and other department personnel as necessary relating to credentialing/recredentialing.
Occasionally make site visits to hospitals for auditing of credentialing files.
Evaluate workflow for speed and efficiency.
Evaluates quality improvement and makes suggestions to supervisor and team members for increasing effectiveness.
Identifies potential problems and proposes solutions.
Maintain credentialing files and related documents, on Issues files.
Participate in training new staff in the credentialing processes and procedures.
Oversee work and maintain orderly and systematic flow.
Enter provider information into the provider database after credentialing has been verified (for delegated providers) or completed for credentialed providers.
Requirements Essential Physical & Environmental Requirements1.
Physical requirements include the ability to sit/stand at a work station for long periods of time, extensive keyboarding, telephone use, filing, bending, reaching, twisting, are required.
Core Competencies1.
Excellent interpersonal skills and ability to work as a team member at all levels of the organization with both internal and external customers.
Outstanding oral and written communication skills including grammar, spelling and general written correspondence skills; strong attention to detail in composing, typing and proofing written materials.
Exceptional organizational and time management skills; ability to establish priorities and handle multiple tasks and projects simultaneously.
Ability to exercise, judgment, diplomacy, discretion and maintain strict confidentiality in a wide variety of internal and public situations.
Is effective and calm under pressure and maintains professional demeanor when times are rough.
Excellent organization skills required on a daily basis to organize and process credentialing files in a systematic, efficient process.
Must be able to focus for long periods on detailed information to ensure proper review and processing of files.
Exceptional customer service skills and an ability to handle various individuals and personalities in a professional and friendly manner.
Will not show frustration when resisted or blocked.
Will exert a settling influence when confronted with a crisis.
Education and ExperienceAssociates degree or higher preferred.
Minimum one year previous healthcare industry or medical insurance experience.
Minimum one year previous experience credentialing, working with providers, medical billing, or claims processing experience required, 3 years preferred.
Intermediate level (or higher) of proficiency with MS Word and Excel.
Why Kelly ?At Kelly Services , we work with the best.
Our clients include 97 of the Fortune 100 (TM) companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward.
If you only make one career connection today, connect with Kelly.
About Kelly Services Kelly Services, Inc.
KELYA, KELYB) is a global leader in providing workforce solutions.
Kelly offers a comprehensive array of outsourcing and consulting services as well as world-class staffing on a temporary, temporary-to-hire, and direct-hire basis.
Serving clients around the world, Kelly provided employment to more than 555,000 employees in 2014.
Revenue in 2014 was $5.
6 billion.
Visit kellyservices.
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