Posted: Friday, February 16, 2018 5:07 PM
The Credentialing Coordinators review providers application, obtains verifications of credentials to procure insurance coverage and confirm that the providers and their employees meet the criteria as established by policy. The Credentialing Coordinators must develop and maintain an excellent working relationship with Network Specialists. They are responsible for Commercial Division Providers nationwide. They may be expected to assist with special projects.
Essential Duties and Responsibilities:
- Reviews Provider Applications and creates credentialing file.
- Data entry of providers information into the database SFDC.
- Maintains current documentation and updates in SFDC.
- Verifies providers credentials by primary source, Internet and clearinghouses.
- Evaluates data and determines suitability of match with providers
- Obtains Insurance Certificates and NPDP:HIPDB self queries.
- Coordinates file review and approval by the Credentialing Committee.
- Networks and coordinates the sharing, receipt, and/or update of information among various internal departments and other regions, if requested.
- Maintains the SFDC Commercial Credentialing database.
- Prepares documents as required for audits and Ad:Hoc reports.
- Collects and submits documents in response to Significant Events, legal requests and any other special requests from Clients and regulatory agencies.
- Obtain copies and/or verifications of expired documents. Uploads copies into SFDC.
- Adhere to all company policies and procedures.
- Adherence to and compliance with information systems security is everyones responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems.
Non:Essential Duties and Responsibilities:
- Perform other duties as assigned.
- High school diploma, GED, or equivalent certificate of competency and transportation work experience.
- Credentialing experience preferred.
Knowledge and Skills:
- Excellent communication skills
- Organizational skills are essential.
- Detail:oriented and able to multi:task.
- Must be able to handle stressful situations and stringent deadlines.
- Must have the flexibility to work longer hours to complete projects as needed.
- Ability to work in a fast paced environment team environment.
- Computer skills required: databases, Microsoft Word, and Excel.
EOE including veterans and disabled
• Location: Tampa
• Post ID: 47398822 tampa