Credentialing Coordinator

Company: True Health
Location: Sanford
Posted on: January 12, 2021

Job Description:

SUMMARYThe Credentialing Supervisor oversees the operation of the Credentialing Department including, but not limited to, the planning and development of activities/procedures to assure compliance with NCQA, CMS, and other health plan credentialing requirements. The Credentialing Supervisor is responsible for negotiating with payer contracts and ensuring the accuracy of practitioner data in both internal databases and health plan directories.PRIMARY FUNCTIONS* Responsible for credentialing activities and supervision of credentialing process.* Oversees, develops, and maintains database programs for credentialing.* Responsible for/assures reappointment process is initiated for each practitioner.* Responsible for initial recommendations regarding bylaw revisions, deletions, additions.* Summarize statistics and committee minutes for monthly reports to Board of Directors.* Plan, develop, and coordinate activities/procedures to assure compliance with NCQA, CMS and other health plan requirements.* Coordinate credentialing audits.* Oversees for the submission of provider credentialing information to health plans for inclusion in Prospect networks.* Direct all Credentialing Department administrative functions.* Oversee and coordinate credentialing activities with contracted CVO.EDUCATION AND EXPERIENCE* Two (2) years college education* AND two 2 years' experience in a Credentialing* Knowledge of NCQA, CMS and Health Plan StandardsKNOWLEDGE, SKILLS, AND ABILITIES* Computer Literate* Knowledge of credentialing functionsRELATIONSHIP REPORTING* Reports to the Manager of Billing & CredentialingPHYSICAL REQUIREMENTS* Able to sit for extended periods of time* Able to perform repetitive hand and wrist movements* Able to view a computer monitor for extended periods of time

Keywords: True Health, Sanford , Credentialing Coordinator, Other , Sanford, Florida