Credentialing Coordinator

Oncology Practice Solutions; Charlotte (NC); On-site; USD 42,000 - 62,000; Full time

Job summary

Oncology Practice Solutions in Charlotte, NC seeks a Credentialing Specialist to lead the review and analysis of practitioner applications, ensuring eligibility and proper enrollment. You will manage credentialing activities, maintain CAQH data, and keep licenses current for physicians and APPs.

The role requires 2+ years in hospital or managed care credentialing, proficiency with CAQH, and strong Microsoft Office skills.

Qualifications

• Minimum 2 years of experience with hospital or managed care credentialing.
• Proficiency with CAQH.
• Computer proficiency and the ability to learn new programs.
• Intermediate to advanced proficiency with Microsoft Office applications.

Responsibilities

• Lead, coordinate, and monitor review of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Ensure providers are credentialed and enrolled in accordance with accreditation, regulatory and policy requirements.
• Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
• Maintain managed care updates in CAQH, and hospital privileges for Physicians and APPs.

Skills

Medical terminology

Credentialing standards

Attention to detail

Organizational skills

Communication skills

Team collaboration

Education

Associate degree in business or related field

Tools

CAQH

Microsoft Office

Job description

• Lead, coordinate, and monitor the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. Ensure providers are credentialed and enrolled in accordance with established accreditation, regulatory and policy requirements.
• Extensive experience in government and commercial managed care.
• Ensure interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing, including compliance with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
• Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
• Maintain managed care updates in CAQH, and hospital privileges for Physicians and APPs (Advanced Practice Providers/Nurse Practitioners).

Skills

• Proficient in medical terminology and understanding of medical office operations
• Knowledge of credentialing standards and managed care requirements
• Strong attention to detail and accuracy in reviewing provider credentials
• Excellent organizational and time management skills to meet deadlines
• Effective communication skills to interact with providers, insurance companies, and other stakeholders
• Ability to work independently and as part of a team in a fast-paced environment

Education and Experience

• Minimum 2 years of experience with hospital or managed care credentialing
• Proficiency with CAQH
• Computer proficiency and the ability to learn new programs
• Intermediate to advanced proficiency with Microsoft Office applications

Preferred Education and Experience

• Associate degree in business or related field

Note: This job description is intended to provide a general overview of the position. Other duties may be assigned as necessary to meet business needs.