Credentialing Coordinator

Viva Health; Birmingham (AL); Hybrid; USD 50,000 - 70,000; Full time

Benefits offered by this job

Comprehensive Health, Vision, and Dental Coverage

401(k) Savings Plan with company match

Paid Time Off (PTO)

Tuition Assistance

Employee Wellness Program

Training and Development Programs

Job summary

Viva Health in Birmingham, AL is seeking a Credentialing Coordinator responsible for credentialing and re-credentialing practitioners within their provider network. The role includes using CAQH data and credentialing software to ensure quality assurance in provider data management.

Qualified candidates should have a Bachelor's Degree, 3 years of credentialing experience, and excellent communication skills. The position offers a hybrid work schedule after a training period that is 100% onsite at their downtown Birmingham office.

Qualifications

• Bachelor's Degree or equivalent experience in credentialing.
• 3 years of experience in credentialing.
• Ability to analyze and solve problems related to credentialing.

Responsibilities

• Receive and incorporate CAQH provider data into the credentialing process.
• Make credentialing decisions based on data and software findings.
• Forecast workload trends based on monthly credentialing data.

Skills

Problem analysis and solving

Data manipulation and reporting

Customer service skills

Communication skills

Microsoft Office proficiency

Education

Bachelor's Degree in credentialing or equivalent experience

Tools

Credentialing software

CAQH

CMS guidelines

NCQA guidelines

JCAHO regulations

Job description

Description

Location: Birmingham, AL

Work Schedule: Hybrid - after a 5-6 month training period that will be completed 100% onsite at our downtown Birmingham office, this position can transition to a hybrid work schedule with a mix of in-office and remote work. The successful candidate must reside within a reasonable travel distance of Birmingham.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals

The Credentialing Coordinator is responsible for credentialing and re-credentialing practitioners, ancillary service providers and allied health professionals to ensure their qualification to participate in VIVA HEALTH’S provider network. The Credentialing Coordinator will serve a primary role in receiving and incorporating provider data appropriately into the provider set-up workflow process. This position will act as a resource for provider data integrity, provider file management and network development.

Key Responsibilities

• Receive, interpret and incorporate Council for Affordable Quality Healthcare (CAQH) provider data into the credentialing, re-credentialing, and provider data auditing process.
• Use CAQH data and credentialing software findings to make credentialing decisions regarding providers.
• Analyze trends in monthly credentialing data to forecast workload for CAQH.
• Communicate with internal departments to ensure quality assurance findings related to providers are reviewed and acted upon accordingly.

Required Qualifications

• Bachelor's Degree or equivalent experience in credentialing
• 3 years of experience in credentialing
• Ability to analyze and solve problems related to credentialing of providers and facilities
• Proficient in manipulation of data to report statistical information to several of departments
• Ability to work independently, research and resolve processing issues in a timely manner with little to no supervision
• Organized, detail oriented, and skilled at multi-tasking
• Demonstrate excellent customer service skills through written and verbal communication
• Proficient in the Microsoft Office suite of products
• Knowledge of credentialing software, CAQH, CMS, NCQA guidelines, and JCAHO regulations

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.