*** QUALIFIED CANDIDATES MUST HAVE EXPERIENCE WITH CREDENTIALING IN TEXAS AND ARIZONA SPECIFICALLY TEXAS AND ARIZONA MEDICAID AND PAYOR EXPERIENCE***
Qualified candidate should possess:
- Must have experience with both Texas and Arizona Medicaid
- Must have extensive Texas and Arizonia credentialing experience
- Must have Payor experience i.e. Anthem, United, BC/BS
- Minimum 2+ years experience in credentialing required
Here we Grow! Because the need to care for children in this age is growing and changing, we are looking for an intelligent, caring Credentialing Coordinator who will join a mission-driven group that is focused on the health of children and the well-being of the family from an operational perspective. Our healthcare practice has grown from its South Florida roots since 1955 across Texas, California, Arizona, New York and there is more to come. At Pediatric Associates, our employees receive competitive salary, a generous PTO program, competitive benefits including a 401K with a Company match of up to 3.5%. With over 65 years of providing LOVING CARE to our patients, we offer the stability and security of an established practice with the excitement of a growing healthcare organization.
Apply on line, email or call us directly, and learn why this is a rewarding career move for you! This is a wonderful time to join our Big Orange PA Family!
Benefits at a glance:
- 3 Comprehensive Medical Plans
- Part Time Medical Plan
- Basic Life and Accidental Death and Dismemberment (AD&D) Company Paid
- Long Term Disability (LTD) Company Paid
- Short Term Disability (STD)
- Voluntary Term Life Insurance (Employee/Spouse/Child)
- 401K Retirement Plan
- Voluntary Benefit Plans
- Life Assistance Plan (EAP)
- Tuition Reimbursement
- Paid Time Off
- Paid Holidays
The Credentialing Coordinator is responsible for organizing, maintaining, verifying, privileging of all aspects of the credentialing process, and maintenance of current provider files including enrollment activities. The employee will have a high level of accuracy and integrity as they ensure provider certifications and files are maintained up-to-date.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
- Obtains timely and accurate primary source verification for initial credentialing and recredentialing functions of providers who work in office or via telemedicine. Responsible for maintaining and updating provider expirables, such as but not limited to malpractice insurance. Licenses, DEAs, board certification. Maintains current database for providers and updates applicable software/system.
- Performs detailed analysis of application and information obtained during primary source verification process. Critical thinking and analysis of this information is crucial to initially determining the credibility of providers. Identifies any discrepancies with any credentialing documentation and history. Escalates significant credentialing discrepancies to the manager.
- Responsible for initial provider enrollment with payers that do not have a delegated credentialing agreement. This includes all requirements for Medicare/Medicaid as applicable. Responsible for provider re-validation/recredentialing applications with payers that do not have a delegated credentialing agreement.
- Responsible for completing required documents/applications for credentialing/recredentialing and privileging providers at hospitals where they are assigned to round.
- Completes, updates and maintains provider CAQH data as needed.
- Research skills to do primary source verification.
- Provides exceptional customer service to providers, administration, and executive staff, as well as external contacts.
- Assists other regions when needed.
EDUCATION: Minimum of High school diploma or equivalent required. Associate’s Degree from an accredited institution preferred. 3 years of related experience is commensurate education required.
EXPERIENCE: Minimum 2 years of credentialing experience preferred.
LICENSURE / CERTIFICATION
Certification in medical staff services by the National Association of Medical Staff Services (NAMSS) or Certified Provider Credentialing Specialist (CPCS) preferred
KNOWLEDGE, SKILLS AND ABILITIES
- Presenting written and oral information in an accurate, clear, succinct, and understandable manner using correct grammar and logical flow of ideas; adapting communication style and tone to fit the situation and engage the audience.
- Meticulously keeping track of details without becoming overwhelmed by them; being exacting, precise, and accurate; spotting minor imperfections or errors and taking action to correct them.
- Identifying the optimal solution using principles of evidence based practice to integrate best practice, research, evidence and job organization, and/or industry expertise with the needs and requirements of the situation.
- Being open to change and considerable variety in work activities; effortlessly adjusting to new or changing situations and unexpected events; altering one’s approach to tasks and projects with minimal loss of efficiency.
- Using inductive and deductive reasoning to formulate general rules or principles and apply them to work; identifying flaws in logical reasoning; understanding complex conceptual relationships; accurately detecting underlying themes or patterns in data.
- Taking an organized approach to work and planning ahead; identifying objectives aligned with business strategies, structuring work and estimating necessary time and resources; anticipating and adjusting for potential obstacles and problems; monitoring work progress.
- Listening to and recognizing the challenges and perspectives of others; sharing information and resources; working cooperatively with others to seek common ground and achieve group goals; proactively adjusting one’s style and efforts to complement those of others on the team; valuing organizational success as much or more than individual success.
- Proficiency with computer skills with a focus on Word and Excel
- Working knowledge of NCQA, AAAHC, state and federal rules/regulations
- Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately.
- Ability to analyze situations accurately and adopt effective course.
- Works independently and is self-directed.
- Demonstrate skills in attention to detail, organization, prioritizing and multi-tasking.
- Credentialing software knowledge a plus.
TYPICAL WORKING CONDITIONS
- Non-patient facing
- Operating Computer
- Reach Outward
- Manual Dexterity
- Lift/Carry 10lbs or less
OTHER PHYSICAL REQUIREMENTS
- Sense of sound
- Sense of touch
Adherence to established standards as mandated by NCQA, AAAHC, state and federal rules/regulations is required.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.