Credentialing Coordinator

Position Purpose: Reporting to the Credentialing Manager, the Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Health Choice providers in alignment with State, Federal, and NCQA standards.

Responsibilities:

• Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations
• Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes
• Identify and communicate agenda items for Credentialing Committee to the Credentialing Manager
• Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file
• Promptly address incoming files for processing
• Review and maintain all applications for accuracy and completeness
• Accurately and efficiently data enter primary source verification data into the credentialing database
• Input credentialing decisions and dates into the credentialing database
• Generate and mail approval letters to participating providers
• Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain
• Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process
• Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing
• Maintain ongoing participation in cross-training activities
• Provide recommendations and feedback regarding process improvements and/or standardization practices
• Actively participate in staff meetings, team huddles, and one-on-one meetings
• Engage in team building activities
• Other duties as assigned