Coordinator, Provider Credentialing-Associate, Days

The Coord, Provider Credentialing-Assoc is responsible for pre-employment and credentialing, verification of licensure, education, and certifications. This role is also responsible for re-credentialing every 2 years. Verification of malpractice insurance and issuing Certificate of Insurance for all NMG providers, non-employed providers, Hospitals, Pharmacies, Labs, etc. across the system each year. Assists all NMG providers and non-employed providers in processing applications in accordance with regulatory and accreditation requirements. Maintains and follows through with the insurance enrollment process for NMG providers, leased providers, contracted providers, Hospitals, Pharmacies, Labs, etc. for the purpose of enrolling the system in health plans contracted with the organization in accordance with the NCQA national guidelines. The Coord, Provider Credentialing-Assoc is responsible for following control processes including requests for change or updates within the systems and follow through skills. Must be competent to work the initial enrollment process. Position includes problem management and troubleshooting. Assists in determining enrollment needs, helps to investigate solutions and presents recommendations to intermediate coordinator and management as needed. Acts as a liaison between NMG providers, non-employed providers, and contracted health plans. Must possess the ability to establish and maintain effective working relationships with all providers, other Credentialing Coordinators, management, and contacts inside and outside the organization. Performs any and all duties necessary to ensure the accurate and timely credentialing for all Providers, Hospitals, Labs, and Pharmacies, etc.

Required:

• With Associate Required Degree, no experience
• Without Associate required degree, two (2) years of experience in healthcare or credentialing.
• Associate Degree

Desired:

• Bachelor Degree