Credentialing Coordinator

West Virginia, Inc.; Buckhannon (WV); Remote; USD 40,000 - 60,000; Full time

Job summary

A leading healthcare organization in Buckhannon seeks a Credentialing Coordinator to oversee the credentialing process for providers. The role includes ensuring compliance with regulations, maintaining accurate records, and facilitating communication with healthcare providers. This position offers remote work after a training period and includes a comprehensive benefits package.

Benefits

Paid Time Off (PTO)

Paid Holidays

Medical Health Insurance

401(k) Voluntary Contribution Plan

Discounted Education Rates

Qualifications

• Two years of relevant experience within an office setting preferred.

Responsibilities

• Lead and coordinate the credentialing process for providers.
• Conduct timely follow-up with providers regarding applications.
• Prepare credentialing files for presentation to the Board.

Skills

Planning

Attention to Detail

Organizational Skills

Independent Judgment

Education

High School Diploma or Equivalent

Associate Degree Preferred

Certified Provider Credentialing Specialist (CPCS) Preferred

Job description

Job Details

Job Location: Buckhannon, WV

Position Type: Full Time

Education Level: High School/GED

Salary Range: Undisclosed

Job Shift: Any

Description

***TRAINING PERIOD UP TO 6 MONTHS BASED ON EXPERIENCE IN FLATWOODS AND BUCKHANNON OFFICES

WILL BE REMOTE AFTER TRAINING COMPLETE***

Job Objective:

The Credentialing Coordinator is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process for all providers who provide care at Community Care of West Virginia (CCWV) facilities. Facilitates all aspects of CCWV credentialing, including ensuring providers are credentialed, appointed, and privileged with health plans, hospitals (as needed), and patient care facilities. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintain a working knowledge of the status and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing applications and related documents. Maintains up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Position Responsibilities/ Essential Duties:

• Makes contact with new providers, explains the CCWV credentialing process and remains available to the provider for additional assistance as needed.
• Conducts timely follow-up with providers regarding application, missing documents, incomplete information as needed.
• Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conducts research and primary source verification of all components of the application file.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.
• Prepares credentialing files for completion and presentation to Community Care of West Virginia Board of Directors, ensuring file completion within time periods specified.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on a day-to-day credentialing issues as they arise.
• Conducts regular internal credentialing file audits.
• Submits and retrieves applicable reports such as the National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
• Maintains copies of current state licenses, DEA certificates, Board certifications and any other required credentialing documents for all providers.
• Monitors the initial, reappointment and expirables process for all medical staff, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, and federal and state), third party contracts, as well as CCWV policies and procedures.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Provides periodic and timely updates to senior management team regarding the status of applications for providers and new sites.
• Prepares, maintains and updates provider collaborative agreements as needed.
• Supports the Mission, Values and Vision of Community Care of West Virginia and the facility.
• Other projects and duties as assigned.

Teamwork:

• Assist in the orientation/training of new Team Members.
• Consistently work in a positive and cooperative manner with fellow Team Members.
• Assist other Team Members in the performance of their assignments.
• Seek out opportunities to help rather than waiting to be asked.
• Consider the impact of your actions on Team Members throughout the Organization.
• Take direction and initiate actions (cross/additional training) that will allow the assumption of cross-functional duties to ensure seamless patient care.
• Demonstrate flexibility to perform duties wherever volume deems it necessary within the Organization.

Problem Solving:

• Demonstrate sound judgment by taking appropriate actions regarding questionable findings or concerns.
• Investigate and follow through on unusual orders or requests for service or information.
• Follow proper reporting procedures for actual or potential accidents and/or incidents so follow-up and/or prevention can occur.
• Record/report the need for service maintenance or repair of equipment and remove any faulty equipment from service.
• Consistently evaluate work and determine if further steps are needed to meet patient expectations.
• Ensure compliance with regulatory standards.

Productivity/ Efficiency:

• Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• Minimize non-productive time and fill slow periods with activities that will enable you to prepare to meet the future needs of the System (education, organizing, housekeeping, assisting others).
• Organize job functions and work area to be able to effectively complete varied assignments within established time frames.
• Consistently demonstrate ability to take the initiative to make decisions/choices without direct supervision.

Adherence to Departmental Policies:

• Demonstrate knowledge and understanding of all policies and procedures and ability to reference them from appropriate books and manuals.
• Comply with infection control policies and procedures CCWV’s Exposure Control Plan which reflects OSHA Bloodborne Pathogens Standard to ensure a safe working environment for self and others.

Great Benefits

• Paid Time Off (PTO)
• Paid Holidays
• Extended Sick Pay (ESP)
• Medical Health Insurance and Prescription Coverage
• Basic Life Insurance for Employee and Family
• Short-Term Disability
• Long-Term Disability
• 401(k) Voluntary Contribution Plan
• Health Reimbursement Account
• Employee Elected Voluntary Coverage for Employee and Family
• Life Insurance, Dental, Vision, FlexibleSpending Account, Dependent Spending Account
• Discounted undergraduate & graduate rates at West Virginia Wesleyan College for employee and family

Qualifications

Education/Qualifications:

Education:

High school diploma or equivalent.

Associate degree preferred.

Certification/Licensure:

Certified Provider Credentialing Specialist (CPCS) preferred.

Experience:

• Two years of relevant experience within an office setting is preferred.

Skills:

• Ability to work independently with minimal supervision.
• Planning: an ability to think ahead and plan over a 1-2 year time span.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent attention to detail.
• Ability to use independent judgment to manage and impart confidential information.

Physical Demands/Working Conditions:

• Work is performed in a professional setting, business casual dress environment.
• Extended periods of sitting and/or standing, telephone and computer work.
• Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.
• Requires occasional lifting and carrying items weighing up to 25 pounds unassisted. Requires frequent bending, reaching, and repetitive hand movements, standing, walking, squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout regular work shift.
• Incumbent will be exposed to virus, disease and infection from patients and specimens in working environment.
• Incumbent will be required to work at any facility and be responsible for own transportation.
• Incumbent may experience traumatic situations including psychiatric, dismembered and deceased patients.