The Credentialing Coordinator is responsible for initial credentialing and re-credentialing nurse practitioners, physician assistants and physicians in a compliant and timely manner; monitor expired credentials and compliance monitoring in accordance with Joint Commission accreditation, NCQA and URAC credentialing standards as required.
* Responsible for the timely and accurate processing of all providers including NP's/PA's/MD's initial and Re-credentialing applications according to the Minute Clinic Provider Credentialing Program
* Monitor Expired licensure reporting , data base tasks and maintain system updates and weekly reporting to leadership
* Manage Epic access for any providers that have out of compliance licensure and/or board certification.
* Conduct sanctions and compliance monitoring and alert Credentialing Manager and Revenue Director of any undisclosed negative findings
* Process malpractice insurance verification requests according to internal policies
* Maintain the provider and physician SharePoint sites and Communicate provider status's with leadership and other internal teams to meet timelines
* Submit system access requests upon credentialing approvals/clinic eligibility
* Support the payer enrollment team as needed to resolve any payer claim issues
* Monitor Provider and Clinic change/Termination reports and update data base accordingly
* Process Name changes according to Minute Clinic policies and procedures
* Daily maintenance of provider credentialing grids with notification to appropriate teams
* Review and distribute all incoming mail as needed
* Support Payer Audits in accordance with Minute Clinic, Joint Commission and NCQA requirements
* Maintain provider files with the most current information/documentation
* Notify system analyst and leadership of any system and state agencies interruptions/updates/password changes
* Make recommendations for process improvement and system efficiencies
* Attend and engage in all team meetings
* Model a positive attitude in interactions with team members
* Demonstrated understanding of initial credentialing and re-credentialing practices for medical professionals including primary source verification methods, compliance monitoring and expireables management.
* Understanding of Joint Commission Accreditation, NCQA and URAC credentialing standards.
* Ability to function independently and utilize critical thinking skills to accomplish goals and objectives
* Effective communication skills; verbal and written
* Strong interpersonal skills including the ability to work well with internal and external stakeholders
* Strong organizational skills and the ability to multitask
* Competent user of Microsoft Office, Outlook, Word, and Excel
* A minimum of 3 years experience in the healthcare industry with experience in credentialing
* NAMSS Certified Professional Credentialing Specialist (CPCS) certification
* Education - Verifiable High School Diploma is required