Credentialing Coordinator
New
Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.Full-TimeMiddle
Salary24.1 - 36.15 USD per hour
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Job Details
- Experience
- Typically requires 3 years of experience in physician credentialing, medical education, a hospital environment and/or health insurance.
- Required Skills
- Microsoft AccessMicrosoft ExcelData entryPowerPoint
Requirements
- High school graduate.
- 3 years of experience in physician credentialing, medical education, a hospital environment, or health insurance.
- Proficiency in Microsoft Office, including Excel, Access, PowerPoint, and Word.
- Experience with credentialing software (MDStaff preferred).
- Knowledge of Joint Commission, NCQA, CMS, DNV, HFAP, OSHA, and state/federal regulatory standards.
- Excellent communication, organizational, and problem-solving skills.
- Ability to sit, operate a computer, and enter data for extended periods.
- Ability to work effectively and independently.
- Certified Provider Credentialing Specialist (CPCS) preferred.
Responsibilities
- Evaluate application requests and initiate the credentialing process.
- Process applications and reappointments, assessing practitioner information for adverse findings.
- Perform quality control on finalized practitioner credentialing files.
- Coordinate biennial review processes to ensure adherence to external accreditation and regulatory standards.
- Document all credentialing events and communication in the database.
- Investigate and verify practitioner background, training, and past practice details.
- Manage external audits for delegated credentialing contracts.
- Evaluate privilege requests against established privilege criteria.
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