Credentialing Coordinator

This is a fully remote position, open to applicants in Oklahoma.

📋 Description

• Process applications and credentialing documentation, ensuring completeness and accuracy.

• Secure primary source verification of provider qualifications, which includes board certifications, facility affiliations, licenses, certifications, DEA, OBNDD certificates, and malpractice coverage.

• Query and process primary source verification and accreditation data from NPDB, OIG, SAM, Revoked Medicare Providers & Suppliers, and Medicare Opt Out.

• Email or fax GlobalHealth Provider Data Forms or UCA applications for initial credentialing and reappointment.

• Download provider applications and accessible primary-source-verified documents from CAQH.

• Prepare credentialing files and present practitioner and provider information to the Credentialing Committee for prompt approval.

• Maintain and update precise credentialing files and databases.

• Communicate with practitioners to ensure that records remain current and consistent.

• Assist the Supervisor of Credentialing, leadership, and the Executive Credentialing Committee in adhering to proper credentialing procedures.

• Inform practitioners and providers of Credentialing Committee decisions and renewal deadlines.

• Respond to inquiries regarding credentialing status.

• Manage, request, and follow up on items with expiration such as licenses, certificates of insurance, and board certifications.

• Save approved documentation to the credentialing drive and uphold provider folder records.

• Maintain confidentiality of credentialing files and Protected Health Information.

• Complete work assignments as requested by the supervisor.

• Keep current desk procedures and reference materials updated.

• Perform additional duties as assigned.

⛳️ Requirements

• High School diploma or equivalent is required.

• Three to five years of experience in credentialing.

• Familiarity with credentialing processes and guidelines.

• Knowledge of primary source verification and relevant resources.

• Proficient in Word, Excel, credentialing databases, Outlook, HAX, and other applications.

• Understanding of credentialing forms and necessary application-processing documentation.

• Awareness of CMS, OSDH, and other accrediting agency standards.

• Strong and precise data-entry skills.

• Exceptional customer service skills and telephone etiquette.

• Capability to communicate effectively.

• Knowledge of practitioner/provider modalities, specialties, and necessary education.

• Ability to maintain accurate databases and documentation.

• Strong organizational and time-management skills.

• Proficient in analyzing situations and employing tact and diplomacy to resolve issues.

• Excellent verbal, written, and organizational skills.

• Self-directed and self-motivated, with analytical, problem-solving, and decision-making capabilities.

• Ability to acquire and retain new skills swiftly while maintaining accuracy.

• Attributes such as alertness, precision, analytical ability, problem-solving skills, memory, communication, creativity, concentration, judgment, imagination, initiative, and persistence.

• A helpful, collaborative attitude with a willingness to learn and support department operations.

• Reliable and secure internet connection is essential.

• Capacity to uphold the confidentiality of business information and PHI in accordance with HIPAA and company policy.

• Must implement reasonable and necessary safeguards to protect company records.

• Some external travel may be required.

• This role does not involve supervisory responsibilities.

🏝️ Benefits

• Fully remote work environment.

• While no specific travel percentage is indicated in the position overview, some external travel is required.

• Access to affordable health insurance coverage through GlobalHealth.