Credentialing Coordinator
CND Life Sciences
- Scottsdale, AZ
- $40,000-50,000 per year
- Permanent
- Full-time
- Oversees the end-to-end technical verification and credentialing process for all new and current physicians in a timely and complete manner.
- Prepares and submits license and credentialing applications, enrollment forms, and related documents to insurance companies, government agencies, and other relevant entities in applicable states.
- Ensures that all licensure, insurance, and certification requirements are current for all practitioners.
- Monitor licensing application progress and proactively follow up to ensure timely submissions including follow-up responses.
- Ensures turn-around-time throughout the credentialing process as defined by the Medical Staff Bylaws for each state and follows through on initial and re-credentialing process for all physicians.
- Coordinates and communicates with internal departments, providers, and external entities to obtain required documentation and resolve any issues or discrepancies with licensing documents.
- Researches incidents, malpractice claims, advisory letters/letters of concern etc. and request appropriate follow-up information from practitioner or other sources as indicated
- Performs relevant data entry and maintains a technical record and regulatory compliance database with credentialing information.
- Processes appropriate queries for expired licensure, or other regulatory licensing and credentialing requirement queries and maintains documentation in the database.
- Handles provider inquiries and problems within the scope of job function and keeps clinical leaders apprised of all issues as they occur.
- Other duties assigned as needed.
- Ensures compliance with regulatory standards, licensing boards, insurance companies, and organizational requirements.
- Maintain and update the credentialing database with accurate provider information, including licenses, certifications, and malpractice insurance.
- Regularly audit and review provider credentials to ensure compliance with organizational and regulatory standards and identify areas for improvement.
- Keep abreast of changes in credentialing requirements, industry regulations, accreditation standards, policies and procedures, and update internal processes accordingly.
- Liaise with internal teams, such as HR, Quality, and Pathology Operations, to ensure alignment of credentialing processes with organizational policies and requirements.
- Obtains primary source and other verifications in accordance with established guidelines.
- Communicate with external stakeholders, including providers, insurance companies, and healthcare facilities, to resolve any credentialing-related issues.
- Assist with the development and implementation of credentialing policies and procedures to enhance efficiency and accuracy.
- Foster positive working relationships with providers, ensuring clear and effective communication throughout the credentialing process.
- Provide support for and documentation of continuing education.
- Maintain reports and records of monthly physician assessments for technical files in close coordination with Pathology Operations team.
- Generates data analytics reports as needed related to physicians and monthly Quality tracking, including status updates per organization policy.
- Identifies areas of improvement related to credentialing, physician compliance and database management.
- Other duties assigned as needed.
- Proven experience in medical credentialing, licensing, or provider enrollment within a healthcare or life sciences organization
- Familiarity with credentialing requirements of regulatory bodies, insurance companies, and healthcare facilities.
- Strong understanding of medical terminology, licenses, certifications, and privileging processes.
- Knowledge of HIPAA regulations and healthcare compliance.
- Demonstrated problem solving skills and adaptability to be successful in a fast-paced, results orientated, changing environment.
- Excellent attention to detail and organizational skills.
- Proficient in using credentialing software and databases
- Effective communication (both verbal and written) and interpersonal skills, preferred experience working with physicians.
- Must be reliable, responsible, and accountable for work performed.
- Ability to work independently and as part of a team, prioritizing tasks and meeting deadlines in a multi-functional task environment.
- Strong problem-solving and decision-making abilities.
- Must have meticulous attention to detail, organization, and excellent time management skills.
- The ability to handle sensitive, confidential information.
- Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
- Provides optimal customer service to meet the organization's expectations.
- Ability to exercise of a high degree of independent judgment in response to complex and sensitive licensing and credentialing issues, decision making and discretion.
- Ability to use independent decision-making processes and handles assigned duties in a meaningful and confidential manner with minimal supervision.
- A minimum of an associate degree in healthcare administration or a related field is required
- Bachelor's degree in healthcare administration, business administration, or science related field (or equivalent experience) is preferred.
- Certified Provider Credentialing Specialist (CPCS) certification a plus
- This position is based at the Company's Scottsdale, Arizona headquarters with the expectation of performing work on site, in-office a minimum of 3-4 days per week.
- Ability to use copiers, fax machines, and PDF scanners to keep inventory and ordering records. Visual acuity and analytical skill to distinguish sufficient detail.
- Must possess the ability to sit or stand for long periods.
- Must possess the ability to perform repetitive motion.