Credentialing Supervisor

				Overview:

The Credentialing Coordinator conducts credentialing and recredentialing in compliance with NCQA and HIPAA standards for internal and external clinicians. Work closely with the Credentialing Manager to resolve issues with health plans, providers and billing offices. Review files and ensures documents are kept up to date meeting all regulatory and contract requirements.

Responsibilities:

* Execute all phases of credentialing for practitioners and facilities.
* Complete credentialing and re-credentialing for facilities and practitioners (as assigned)
* Contact practitioners for information to comply with all federal, state and local guidelines.
* Maintain files with current documentation for individuals and facilities.
* Complete and track contracted health plan credentialing & enrollment for practitioner & facility.
* Serve as a company source of information regarding the status of credentialing activities.
* Maintain credentialing database.
* Monitor practitioner and facility status in both internal and external data systems.
* Monitors license status of practitioners and facilities; and manage system information for alerts on licensing expiration.
* Request updates of expired documents
* First level contact to assist in trouble shooting basic credentialing issues.
* Conduct orientation of new and existing employees 
* Coordinate training and educational requirements for credentialing staff.
* Works closely with department Director to assess needs for expansion of new products
* Participate in development and coordination of departmental Credentialing Quality Improvement (CQI) initiatives.
* Maintain a constant level of professionalism and customer service
* Communicate with practitioners, data banks, state licensing and regulatory bodies, educational programs, health plans, and other divisions within the company.
* Prepare standard documentation for Credentialing Committee and distribute to committee members.
* Serve as a non-voting member of the credentialing committee; maintain minutes and agenda for the monthly meetings.
* Support credentialing team as needed to accomplish tasks and time sensitive department requests.

Qualifications:

Required:

* High school diploma or GED equivalent.
* Minimum two (2) years of credentialing/recredentialing experience or equivalent. 
* Demonstrated commitment to exceptional professionalism, confidentiality and service to customers. 
* Exceptional communication skills for accurate, concise, and organized verbal and written communication. 
* Strong ability to multi-task. Requires self initiative. 
* Good interpersonal skills and ability to build professional relationships. 
* Ability to work effectively as a team member. 
* Effective organizational, time management and planning skills. 
* Knowledge of Windows based office technologies (i.e. Word, Excel, etc.). 
* Maintain regular attendance.
			

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