Credentialing / Contracting Coordinator

글쓴이: hans  |  등록일: 09.13.2018 08:59:40  |  조회수: 63
Credentialing/Contracting Coordinator

Responsible for data entering, gathering, and primary source verification of healthcare practitioner information, including in-depth, detailed, or challenging research of information. Primary methods of researching information include internet, phone, fax, e-mail, and letters. Responsible for expanding/maintaining the provider network through contracting efforts.

Essential Functions


Contact providers to initiate initial credentialing or re-credentialing
Update expiring documents such state licenses, DEA licenses, and malpractice insurances
Manage and organize the credentialing folders and files
Data entry into the provider database
Contact providers for follow-up calls
Assist in the contracting processes; successfully obtain contracts or LOAs from providers
Create monthly credentialing meeting minutes
Assist the department with regular health plan audits
Performs other duties as assigned

Obtain contracts and letters of agreement (LOAs) from providers who want to join our network
Initiate initial credentialing on providers who want to join our network
Maintain and ensure network adequacy for the IPAs
Coordinate with other departments to obtain contracts/LOAs with requested providers
Call/follow-up with providers on a daily/regular basis to obtain contracts/LOAs
Prepare contracts/LOAs for board signatures
Negotiate Medicare reimbursement rates with prospective providers
Assist in provider network audits

High school graduate/diploma
Must be familiar with the credentialing process; with what type of organization/company an MSO is; with health care and managed care; with ICE and NCQA credentialing standards
Able to follow-up on calls, emails, faxes and obtain results
Have clear and concise phone and verbal communication skills
Comfortable being on the phone frequently
Ability to write legibly
Demonstrate effective written communication skills
Have strong computer, typing, and data entry skills: includes MS Word, Excel, and web-based application, internet, and database programs
Detail oriented with ability to recognize vital information from verification documents
Possess proof-reading skills sufficient for auditing documents
Ability to prioritize well and meet overlapping deadlines
Demonstrates problem-solving, critical thinking, and deductive reasoning skills
Ability to consistently maintain quality and production expectations

Monday to Friday

8:30 AM to 5:30 AM

Job Type: Full-time
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