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Credentialing Coordinator

Job Overview
Job Order:JO00020002
Date Posted:Feb 16
Salary:$17.00/Hour
Category:4 - Clerical/Administrative
Metro Area:

Looking for a Credentialing Coordinator for our client located in Troy, MI area for a Contract-to-Direct position.

Summary:

• Responsible for all aspects of the CAQH credentialing application and verification process for initial and re-credentialing requests. Assess completeness of information and practitioner qualifications relative to regulatory standards and guidelines including NCQA, CMS, MDCH and HAP's established standards; maintain credentialing files according to regulatory standards and guidelines including NCQA, CMS MDCH, and HAP's standards.
• Assure all practitioner data is accurate and up-to-date in the CACTUS credentialing software application, including generating and monitoring reports.
• Responsible for on-going communication with internal and external customers. Respond to all correspondence within 48 hours. Consult with management quickly if unable to resolve within expected time frame.
• Coordinate, implement, analyze and close annual delegated audits, as assigned. As issues are identified, resolution must be documented and completed in a timely manner and in accordance with regulatory standards.
• Organize and maintain practitioner files following confidentiality guidelines.
• Extract and present key information including CAQH credentialing application and credentials, and identification of potential practitioner issues to facilitate the Credentials Committee decision-making process.
• Maintain tickler systems for follow-up of unanswered correspondence to maintain department standards for application processing time.
• Participate in all data integrity projects, as identified.
• Provide cross-coverage for other analysts, as needed.

Skills:

• Minimum of two (2) years’ experience in managed care experience.
• Minimum of two (2) years’ experience in physician credentialing.
Preferred:
• Minimum of two (2) years’ CACTUS physician credentialing software experience
• Knowledge of Council for Affordable Quality Healthcare (CAQH) Practitioner Application

Skills and Abilities:
• Ability to work under minimal supervision.
• Ability to perform detail work efficiently and with a high degree of accuracy.
• Excellent problem-solving skills.
• Ability to initiate and coordinate multiple projects simultaneously.
• Ability to interpret information and make judgements quickly.
• Ability to interact professionally with practitioners and other external customers.
• Strong quantitative and analytical skills.
• Computer proficient in Microsoft Office including; Word and Excel
• Knowledge of the principles and practices of credentialing is highly desirable.

Education:

• Associate’s degree in business, health care or related field or four (4) years of related experience in healthcare industry, managed care experience in lieu of degree.

Preferred:
• Bachelor’s degree in business, health care or related field preferred

Certifications/Licensures Required:
• Certification as CPCS (Certified Provider Credentialing Specialist) or CMSC (Certified Medical Staff Coordinator) preferred.

If you are a high performer and would like to work for an equally high performing company and you think the above opportunity is appropriate for you, we invite you to apply to this job and email your resume to rrice@hrsus.com.

We treat all resumes with strict confidentiality. We will always contact you first before submitting your resume to our client(s) for review. If you do not receive correspondence, you are not a fit for this position.

At Harvard Resource Solutions, our talent acquisition team is proud to provide our clients with the most qualified Administrative & Clerical talent in the industry today.