Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status.
Senior Credentialing Coordinator
Location
United States
Posted
1 day ago
Salary
$23 - $26 / hour
Seniority
Senior
No structured requirement data.
Job Description
Senior Credentialing Coordinator
Claritev
Role Description This position is responsible for providing coaching, operational, and infrastructure support to an operations team responsible for credentialing and recredentialing of practitioners and facilities who are currently contracted or wish to be contracted with the Company. This position will research and consult on standard and escalated practitioner and facility credentialing matters. Duties - Assist Team in daily responsibilities to meet team performance goals to include inventory monitoring and reporting. - Manage high priority and specialized requests as appropriate. - Reviews, analyzes, and reports on individual, team and department data for trends, gaps, and variances from department performance standards. - Ensure all credentialing processes are in compliance with company policies as well as the National Committee for Quality Assurance (NCQA) standards in an effort to maintain accreditation. - Provides development and coaching to employees on a consistent basis. Feedback is provided in a timely manner and suggestions for improvements are outlined. - Create and maintain internal training materials in collaboration with department management and training teams. - Leads training efforts of new team members. - Leads mentor, audit, and readiness efforts of new team members and those on a performance improvement plan to identify and model best practice. - Assists Department with operational tasks associated with credentialing operations. - Participates in projects that involve the collection of credentialing applications. - Participates in projects, as a subject matter expert that involve system design/re-design related to credentialing operations. - Tests all credentialing operations related system(s) design/re-design related to credentialing operations. - Serve as a subject matter expert for all credentialing activities performed within assigned areas including the education and training of staff extenders on credentialing methodologies and approaches, with an emphasis on operational efficiency and quality optimization. - Utilizes knowledge outside of team's standard procedures to increase contextual understanding of processes. - Ability to compose and present communications describing tasks and overall context, including existing process guidelines as well as associated risks and controls. - Collaborate, coordinate, and communicate across disciplines and departments. - Ensure compliance with HIPAA regulations and requirements. - Demonstrate Company's Core Competencies and values held within. - The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary. Qualifications - Minimum High School Diploma or G.E.D. Bachelor's degree in a relevant field preferred. - Minimum 2 years of experience in provider credentialing preferred. - Experience with team member coaching/mentoring or ability to coach/mentor preferred. - Communication (written, verbal, listening), leadership, problem-solving, and organization skills. - Ability to engage staff at all levels to work toward unified goals and objectives. - Ability to prioritize their work and the work of others to meet rigorous productivity goals and standards. - Ability to present and speak publicly. - Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, Microsoft Word, and Excel, etc. - Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone. Requirements - Compensation: The salary range for this position is $23 to $26 per hour. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity. Benefits - Medical, dental and vision coverage with low deductible & copay. - Life insurance. - Short and long-term disability. - Paid Parental Leave. - 401(k) + match. - Employee Stock Purchase Plan. - Generous Paid Time Off – accrued based on years of service. - 10 paid company holidays. - Tuition reimbursement. - Flexible Spending Account. - Employee Assistance Program. - Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits. EEO Statement Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. Application Deadline We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.
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• Credentialing all the Physicians and Allied Health Professionals • Processes credentialing and re-credentialing applications of health care providers • Obtain required paperwork, reviews applications, and prepares verification letters • Utilize the IntelliCred credential software program • Contact medical office staff, licensing and government agencies, and insurance carriers
• Coordinates the processes for medical staff/advanced practice professional credentialing • Verifies and collects documents that support eligibility threshold for privileges • Processes initial and reappointment applications and privileging requests • Creates accurate credentialing reports for review and recommendations
• Supports the CVO’s application process, credentialing verification, expirable management and ongoing monitoring work for contracted healthcare organizations. • Ensures clients and providers have a positive experience by providing quality service and communication. • Coordinates provider application and primary source verification process using CVO credentialing platform. • Manages provider application process including sending electronic applications to providers per client requests, evaluating the received application for completeness, resolving incomplete application information, accepting information into credentialing platform following CVO policies and procedures. • Communicates with applicants and designated administrative support to resolve application requirements and incomplete data in a professional manner. • Manages primary source verifications for provider applications including ensuring the verification of credentialing information from the provider’s application is correct and from primary sources, tracking fees for verifications, following up on non-received verifications needed to close files, and tracks information following CVO policies and procedures. • Communicates professionally with applicants, designated administrative support and primary source organizations on verification discrepancies, information needs and requirements. • Manages ongoing expirables for providers primary state license, board certification, DEA/CDS and malpractice insurance for contracted clients. • Manages ongoing monitoring of sanctions for contracted clients for state licenses, Medicare and Medicaid and Medicare Opt-Out. • Provides a monthly report of outcomes. • Stays informed on all client criteria requirements to ensure requirements are applied to files through the application and verification process. • Communicates with providers and client questions and concerns regarding a variety of issues related to the processing of credentialing applications. • Tracks and obtains fee verifications; follows department policies and procedures standards for check requests and credit card usage. • Supports the billing process for verification services. • Maintains and updates the database reference tables in accordance with internal policies and procedures with current contact information following data standardization protocols. • Maintains own professional growth through participation in seminars, conferences, in-service programs and self-directed learning activities. • Contributes to the team efficiency by providing support both operationally and administratively. • Assists with special projects and tasks as requested.
