Insurance Credentialing Coordinator

POSITION PURPOSE:

Responsible for the direct oversight and execution of the credentialing/re-credentialing process for all Partners in Hope licensed, registered, certified, and other clinical staff. This position works with and supports the provider team, human resources, contracting, compliance, and any credentialing committees/subcommittees. The Credentialing Manager Provides leadership, management and operational oversight of the Credentialing Department includes credentialing and privileging processes, medical staff quality and peer review processes and assurance of compliance with medical staff bylaws and policies.


RESPONSIBILITIES:

Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.
Fully knowledgeable of credentialing requirements and regulations on state and federal levels as it pertains to a Federally Qualified Health Center (FQHC).
Fully knowledgeable of credentialing requirements for all applicable provider types.
Execute the various external functions associated with credentialing, re-credentialing, and privileging of Aviva Health’s licensed, registered and certified staff. Ensures accuracy and timely submission of credentialing requests.
Responsible for creating and maintaining a system of detailed internal reports of relevant metrics and distributing to the credentialing committee.
Facilitates the Medical and Dental Credentialing Committee meetings and follow up action.
Understanding and adhering to the Health Resources and Services Administration (HRSA) guidelines regarding privileging and credentialing.

QUALIFICATIONS:

Current certification by the National Association Medical Staff Services (NAMSS) for Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services.
If not certified as CPMSM upon hire, must become certified within 6 months of hire.
Minimum 5 years’ experience in the Medical Staff Services / Credentialing profession.
1 to 3 years supervisory experience preferred.