Credentialing Coordinator

Socket.dev; Chicago (IL); On-site; USD 42,000 - 58,000; Full time

Job summary

Zing Health seeks a Credentialing Coordinator to manage all credentialing materials, perform verifications, and maintain provider credentials. You will build relationships across Zing Health’s network and internal teams to ensure timely processing of credentialing files.

Responsibilities include reviewing applications, verifying licenses and malpractice history, and producing regular credentialing reports. Strong organization and communication skills are essential for success in this role.

Qualifications

• Navigates complex health plan enterprise systems and policy criteria.
• Analyzes data to identify trends and variances from goals.
• Comprehends JCAHO and state/federal credentialing requirements.

Responsibilities

• Ensure credentialing files are complete with necessary documentation.
• Review applications, perform primary source verification, and forward files for processing.
• Audit provider directories and generate network/ad hoc reports.
• Support Credentialing Committee meetings and manage multiple tasks efficiently.

Skills

Navigate complex health plan systems

Data analysis

JCAHO standards knowledge

Autonomous working

Effective communication

Attention to detail

Microsoft Office

Education

High School Diploma

Tools

Microsoft Office

Job description

COMPANY OVERVIEW

Zing Health is a tech-enabledinsurance company making Medicare Advantage the best it can be for those65-and-over. Zing Health has a community-based approach that recognizes theimportance of the social determinants of health in keeping individuals andcommunities healthy. Zing Health aims to return the physician and the member tothe center of the health care equation. Members receive individualized assistanceto make their transition to Zing Health as easy as possible. Zing Health offersmembers the ability to personalize their plans, access to facilities designedto help them better meet their healthcare needs and a dedicated care team. Formore information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

Coordinate the process ofgathering all credentialing materials. Assistwith completion of credentialing new and established health careproviders. Maintains and updatesprovider credentialing database. Abilityto build relationships with all levels of personnel within the Zing HealthNetwork organization and external provider networks.

ESSENTIAL FUNCTIONS:

• Assures credentialing files are completewith the necessary documentation
• Reviewcredentialing applications, apply policy and criteria, perform primary sourceverification, process files and forward completed files to appropriate area forprocessing
• Monitors and conducts appropriatefollow-up regarding supportive credentialing documentation including currentlicensure, malpractice status and history, board certification, and relatedfunctions according to established time frames.
• Review monthly regulatory and disciplinary actionreports issued by State licensure bodies and the Office of Inspector GeneralMedicaid and Medicare Sanctions reports.
• Understand credentialing requirements per Zing Healthpolicies, as well as state and federal requirements.
• Audit provider directories.
• Produce regularlyscheduled network and ad hoc reports.
• Attend andprovide support for Credentialing Committee meetings.
• Demonstrate consistent ability to multi-task,prioritize and perform independently to execute assigned tasks.
• Special projects as assigned or directed.

QUALIFICATIONSAND REQUIREMENTS:

JOB REQUIREMENTS:

• High School Diploma
• Two (2)+ years of previousmanaged care insurance or physician credentialing experience required
• Ability to navigate complexhealth plan enterprise systems.
• Ability to analyze data foridentifying trends, and variance from goals.
• Ability to comprehend JCAHOstandards and state and federal laws related to credentialing.
• Ability to work autonomously.
• Efficient and concisecommunication skills.
• Attention to detail, organizedand have excellent time management capabilities
• Microsoft Suite knowledge amust.