The Credentialing Coordinator ensures that all Caring Health Center providers who are independently licensed and who are in the medical, dental or behavioral health departments are fully credentialed and privileged by the Caring Health Center Board of Directors and are fully credentialed with the health insurance companies with which CHC conducts business.
Reports to: Human Resources Director
Associates’ degree in Business, Healthcare or related field
Prior experience in Credentialing
Strong oral and written communication skills.
Able to work independently.
Organized, with excellent attention to detail.
Knowledge of commercial health insurance industry and industry practices.
Ability to maintain confidential information.
Principle Responsibilities and Duties:
Oversee all primary and secondary source verification activities
Track license, certification, DEA, and controlled substance registration expirations for each provider and ensure timely renewals
Ensure new clinicians are scheduled for review at the Staff Credentialing Committee meeting and existing physicians are re-credentialed in a timely manner
Ensure timely processing of clinicians into CAQH system
Ensure new providers and other professional medical staff files are complete and contain all necessary applications and licenses relative to the credentialing and privileging process
Complete all privileging and credentialing applications with all insurers to maintain Caring Health Center ’s ability to collect reimbursements
Maintain all credentialing and privileging files in accordance with CHC, HRSA, and other regulatory bodies
Work closely with Massachusetts Board of Registration in Medicine, MCSR, DEA, insurance carriers, and other licensing bodies in resolving any issues that may arise with credentialing, privileging, or appointment/reappointment of Caring Health Center providers
Process credentialing applications and reappointment paperwork, checking for full completeness and accuracy
Process applications, reappointment paperwork, and maintain records and databases pertinent to credentialing
Constantly collect and process significant amounts of verification and other information and must constantly maintain and update accurate databases - these databases include pertinent education information, training, CEU’s, experience, and licensure content .
Prepare own records for regular auditing
Assists in Quality Assurance and Risk Management activities.
Assists with Human Resources functions as needed
This position requires compliance with Caring Health Center’s compliance standards, including its Standards of Conduct, Compliance Program, and policies and procedures. Such compliance will be an element considered as part of the Credentialing Coordinator’s regular performance evaluation.
From time to time, this position requires the ability to work long and arduous hours.