Credentialing Coordinator

Talentify; Town of Texas (WI); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Talentify is seeking a Credentialing Coordinator for our client, with a Farmers Branch, TX or remote work arrangement. You will manage credentialing applications, primary source verifications, and maintain the credentialing database to ensure NCQA and CLIA-type compliance.

The role reports to the Credentialing Supervisor and requires 1–3 years in credentialing, familiarity with NCQA standards, and NAMSS CPCS certification within 2 years of eligibility.

Qualifications

• 1-3 years of credentialing experience in a healthcare setting.
• Familiar with NCQA accreditation standards and requirements.
• Excellent communication and collaboration skills for internal and external stakeholders.
• Strong problem-solving and time-management abilities.
• Detail-oriented with accuracy in credentialing records and databases.

Responsibilities

• Ensure clinicians pass the credentialing process successfully.
• Assist with completion of credentialing applications and primary source verifications.
• Maintain MD Staff credentialing database and ensure NCQA/compliance standards.
• Review and process credentialing and re-credentialing files on a timely basis.
• Query organizations and verify provider eligibility for specific state/licensure requirements.
• Prepare files for Credentialing Committee presentations and maintain PHI security.

Skills

Active listening

Interpersonal skills

Problem-solving

Organizational skills

Education

High school diploma or equivalent

Tools

Google Suites

Job description

About this job

Our client, a Healthcare company, is looking for a Credentialing Coordinator for their Farmers Branch, TX/ Remote location.

Responsibilities

• The Credentialing Specialist ensures clinicians successfully pass the Client credentialing process.
• This role is responsible for assisting clinicians with the completion of their credentialing applications, performing primary source verifications, and maintaining the MD Staff credentialing database.
• The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements.
• This position reports to the Credentialing Supervisor
• Review and process credentialing and re-credentialing files.
• Establish and maintain a system for the timely processing of credentialing files in accordance with NCQA policies.
• Query appropriate organizations and evaluate responses to ensure provider compliance with NCQA standards.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.
• Review all background checks, drug tests, and TB screenings and record the results.
• Assemble all verified information and prepare files for presentation to the Credentialing Committee.
• Verify providers’ requirements for approval to work in specific states and plans.
• Assist with the ongoing monitoring of contracted clinicians.
• Utilize the MD Staff credentialing database to perform queries, generate reports, and optimize efficiency.
• Provide administrative support to department leadership and both internal and external stakeholders.
• Maintain professionalism at all times 17and provide timely, professional responses to all emails.
• Actively demonstrate teamwork and assist with special projects.
• Responsible for the security and privacy of any protected health information (PHI) accessed during work activities..

Requirements

• 1-3 years of successful work experience in a credentialing role/department.
• Intermediate skills with Google Suites.
• Must be familiar with NCQA accreditation standards.
• Demonstrate active listening skills and the ability to provide and receive constructive feedback
• Strong interpersonal skills, with the ability to build rapport and productive relationships with internal and external stakeholders
• Obtain NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) within 2 years of eligibility to certify.
• Working knowledge of problem-solving and decision-making skills.
• Ability to organize and prioritize workload and day-to-day tasks.
• High school diploma or up to 1 year of equivalent experience.

Why Should You Apply?

• Referral Program
• Excellent growth and advancement opportunities