Coordinator, Provider Credentialing-Senior, Days

Under minimal supervision, the Coord, Provider Credentialing-Sr defines the scope of the departmental processes based on needs. Devises or modifies processes based on state, government, or health plan requirements. Analyzes and revises existing processes, reporting, and documentation as necessary. Assigns new NMG providers and non-employed providers to coordinators as well as projects as needed. Responsible for maintaining and following through with the insurance enrollment process for facilities, pharmacies, labs, NMG providers and non-employed providers for the purpose of enrolling in health plans contracted with the organization. The Coord, Provider Credentialing-Sr is responsible for following control processes including requests for change or updates and follow through skills. Must be competent to work at the highest level of all phases within the enrollment process and help to investigate solutions and present recommendations to management and Chief Revenue Officer as needed. Serves as a liaison between facilities, pharmacies, NMG providers, non-employed providers, and contracted health plans. Must possess the ability to lead less experienced coordinators, establish and maintain effective working relationships with all providers, all credentialing coordinators levels, leadership, and contacts inside & outside the organization.

Required:

• With required degree, three (3) years of experience in healthcare and/or credentialing
• Without required degree, seven (7) years of experience in healthcare and/or credentialing.
• Bachelor degree

Desired:

• Three (3) years of experience in credentialing