Credentialing Coordinator at Seattle

Job Description

COMMUNITY HEALTH PLAN

Credentialing Coordinator

 

 

 

KEY RELATIONSHIPS:

Reports To: Supervisor, Credentialing  

 

Supervises: Non-Supervisory Position  

 

Other Key Relationships:  Provider Relations Coordinators, Provider Operations Coordinators, Contracting, Customer Service, Dell-Perot TPA, In-Network and Out-of Network Provider Medical Groups.

 

FLSA:  Non-Exempt 

 

POSITION PURPOSE:

 

This position will be responsible for providing comprehensive administrative support to the Credentialing Department, to provide initial assistance to providers undergoing credentialing, and to aid in the maintenance of various areas of the CACTUS credentialing database. 

 

PRINCIPLE DUTIES:

 

• Prepare and mail notification letters for practitioner credentialing and recredentialing.
• Monitor new applications made available to CHPW on the One Health Port online system.
• Track expired credentialing, running reports to make sure there are no credentialing expired providers or facilities listed as active, and get applications sent if necessary to bring the providers back into compliance.
• Prepare and maintain the practitioner credentialing files both physical and electronic.
• Monitor credentialing statistics.  Monthly tracking of how many applications were received, who completed the data entry, and who received the application for processing.
• Prepare and mail welcome letters to the providers that have been approved in the file reviews or at committee.
• Run reports to notify Contracting department of recently approved or denied initial providers.
• Run report to prepare provider list for Medical Director for the file reviews and committee meetings.
• Maintain the Medicare Opt-out list, including checking each provider to see if they’re PAR and terming if necessary, and re-opening Medicare products if the provider didn’t renew their opt-out.
• Manage the Credentialing Committee meeting preparation, including materials, minutes, scheduling and coordination with the participants.
• Answer provider questions regarding credentialing status, credentialing process, and other credentialing questions and occasional contracting questions.
• Answer provider questions regarding accuracy of database information and status of demographic updates and refer providers to our provider changes email inbox and provider operations when needed.
• Generate ad hoc Cactus reports
• Conduct ad hoc internal training on credentialing department records and processes.
• Provide input into revision of provider notification and credentialing documents and processes.
• Coordinate staff meeting minutes.
• Occasionally assist with delegated provider updates by updating Cactus and sending PACT forms to Dell.

Job Requirements

Education

• High School Diploma or GED required

 

Prior Related Experience

• Two (2) years of work experience in administration support, including data entry and data analysis. Excellent computer skills with knowledge of Word, Excel and Cactus. Experience in provider file maintenance is preferred.

 

Employment Eligibility:

• Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

 

Knowledge, Skills, and Abilities

• Good oral and written communication skills.
• Ability to meet scheduled deadlines with minimal supervision.
• Strong organizational skills and accurate work results.
• Strong ability to comprehend and work efficiently with large systems of high complexity.
• Strong problem solving skills and tenacity to follow through research to ensure the best and most accurate result is achieved.
• Commitment to a philosophy that supports single contact resolution.
• Self starter, ability to work with minimal direction.
• Ability to meet scheduled deadlines with minimal supervision.
• Ability to maintain a professional demeanor and confidentiality

 

 

SENSORY/PHYSICAL/MENTAL REQUIREMENTS

 

Sensory:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical:

• Extended periods of sitting, computer use, talking and possibly standing.
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.

Mental:

• Frequent decision-making. Ability to gather and assess data, determine appropriate actions, apply protocols and knowledge to unique situations, problem-solve and provide consultation.
• Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Country: USA, State: Washington, City: Seattle, Company: Community Health Plan of Washington.