Provider Coordinator (52303)
RemoteUnited States
Job Summary
Verify provider data integrity by monitoring records, responding to daily inquiries, and resolving issues within JIRA. Assist in maintaining accurate provider and vendor records while educating providers to maximize data integrity. Coordinate initial and recredentialing processes for providers, obtaining primary source verification of competencies including board certifications, licensure, and malpractice coverage. Process credentialing applications, query databases for NPDP, OIG, and Medicare Opt Out information, and prepare files for the Credentialing Committee. Notify practitioners of committee decisions and manage expirable credentials such as licenses and COIs. Collaborate with vendors to validate data accuracy and ensure compliance with CMS and state regulatory requirements. Maintain confidentiality of all credential files and Protected Health Information in accordance with HIPAA policies.
Required Qualifications
- High School diploma or equivalent
- Three to five years of credentialing experience
- Ability to manage multipole priorities and meet deadlines in a fast-paced environment
- Knowledge of CMS, NCQA and state regulatory requirements related to provider credentialing and directory accuracy
- Demonstrated proficiency in the use of personal computer applications; specific skills to include Microsoft Word, Outlook, Excel v-lookup, and ability to build and compare files
- Ability to quickly develop rapport and work effectively and professionally with all levels of personnel
- Ability to investigate/research problems and issues and to recommend associated corrective actions
- Ability to manage sensitive or confidential information in a professional and discreet manner
- Ability to analyze situations and use tact and diplomacy to arrive at resolutions
- Proper organizational/time management skills
- Self-directed/initiative-taking
- Analytical, problem-solving and decision-making abilities
- Alertness, precision, analytic ability, problem solving, memory, communication, creativity, concentration, judgment, imagination, initiative, resilience to push through barriers to the solution
- Must have access to a reliable and secured internet connection source
- Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy
Desired Qualifications
- Preferred experience with Medicare Advantage plans
- Working knowledge of credentialing processes and guidelines primary source verification
- Knowledge of types of modalities, specialties, and education required for each practitioner and provider
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