Credentialing Coordinator

Position Summary: This position is responsible for the initial credentialing and re-credentialing of network providers, and for the maintenance of provider credentialing files, electronically and on paper. Complies with the HS1 Credentialing Program Description which meets URAC and AHCA requirements.

- Receive and process all credentialing/re-credentialing applications according to Company policies and procedure. Maintain accurate and complete records as to the status of each application.

- Data Entry of provider information into the computer system.

- Prepare new provider applications and re-credentialing applications for the Credentialing Committee to review.

- Attends Monthly Credentialing Committee meetings as needed and assist in preparation for meeting.

- Maintain initial and re-credentialing established timelines

- Communicate with providers to update expired credentials, clarify information and other credentialing related issues for initial and re-credentialing.

- Maintain a strict level of confidentiality for all matters pertaining to provider credentials.

- Ensures compliance with and/or adheres to company HIPAA policies and procedures.

- Ensures integrity of data entered into company systems and/or databases.

- Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.

- Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.

- Ability to come to work and work the regular schedule and shift for the position.

- Perform additional duties and related essential duties as assigned.

- High school diploma or general education degree (GED) College experience preferred.

- Two years or more of managed care credentialing experience.