Credentialing Coordinator (Hybrid - Troy, MI) - Health Alliance Plan

Henry Ford Health System
United States, Michigan, Troy
Jan 07, 2025
GENERAL SUMMARY: Under minimal supervision, responsible for initial and re-credentialing functions including completion of the application and verification process, Credentialing Committee preparation and follow-up, coordination with contracting and interaction with practitioners, office staff and network representatives. PRINCIPLE DUTIES AND RESPONSIBILITIES: Responsible for all aspects of the CAQH credentialing application and verification process for initial and re-credentialing requests. Assess completeness of information and practitioner qualifications relative to regulatory standards and guidelines including NCQA, CMS, MDCH and HAP's established standards; maintain credentialing files according to regulatory standards and guidelines including NCQA, CMS MDCH, and HAP's standards. Assure all practitioner data is accurate and up-to-date in the CACTUS/symplr Provider credentialing software application, including generating and monitoring reports. Responsible for on-going communication with internal and external customers. Respond to all correspondence within 48 hours. Consult with management quickly if unable to resolve within expected timeframe. Coordinate, implement, analyze and close annual delegated audits, as assigned. As issues are identified, resolution must be documented and completed in a timely manner and in accordance with regulatory standards. Organize and maintain practitioner files following confidentiality guidelines. Extract and present key information including CAQH credentialing application and credentials, and identification of potential practitioner issues to facilitate the Credentials Committee decision-making process. Maintain tickler systems for follow-up of unanswered correspondence to maintain department standards for application processing time. Participate in all data integrity projects, as identified. Provide cross-coverage for other analysts, as needed. Perform other related duties as assigned. EDUCATION/EXPERIENCE REQUIRED: Associate's degree in business, health care or related field or four (4) years of related experience in healthcare industry, managed care experience in lieu of degree. Bachelor's degree in business, health care or related field preferred. Minimum of two (2) years of experience in managed care experience. Minimum of two (2) years of experience in physician credentialing. Minimum of two (2) years of CACTUS/symplr Provider physician credentialing software experience preferred. Knowledge of Council for Affordable Quality Healthcare (CAQH) Practitioner Application preferred. Ability to work under minimal supervision. Ability to perform detail work efficiently and with a high degree of accuracy. Excellent problem-solving skills. Highly organized. Ability to initiate and coordinate multiple projects simultaneously. Excellent verbal communication skills. Ability to interpret information and make judgments quickly. Ability to interact professionally with practitioners and other external customers. Strong quantitative and analytical skills. Computer proficient in Microsoft Office including; Word and Excel Knowledge of the principles and practices of credentialing is highly desirable. CERTIFICATIONS/LICENSURES REQUIRED: Certification as CPCS (Certified Provider Credentialing Specialist) or CMSC (Certified Medical Staff Coordinator) preferred. Additional Information Organization: HAP (Health Alliance Plan) Department: Provider Network Operations Shift: Day Job Union Code: Office/Non-Exempt, HAP