Credentialing Coordinator I at MultiPlan in Bedford, Massachusetts

Job Description:

Job Description

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talented individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

JOB SUMMARY: This role coordinates all aspects of the credentialing and recredentialing processes for providers whom are currently contracted or wish to be contracted with the company. The incumbent will ensure continual maintenance of data for each provider within the credentialing databases. The roles tasks the incumbent with the research, verification, and evaluation of credentialing data from online systems in order to ensure timely verification of licenses and certifications. Additionally, the role works to ensure complete and accurate provider credentialing records for review by the credentials committee.

JOB ROLES AND RESPONSIBILITIES:

1. Lead, coordinate, and monitor the review and analysis of provider applications and accompanying documents, ensuring applicant eligibility by investigating company approved credentialing systems.


2. Conduct thorough background investigation, research and primary source verification of all components of the application file. Responsible for primary source verification which may include medical school, National Practitioner Data Bank (NPDB), licenses, certifications, hospital affiliations, rainingprograms, and accreditation.


3. Processes provider credentialing applications in accordance with National Committee for Quality Assurance (NCQA) standards, regulatory requirements, and policies and procedures.


4. Examine, research, enter data, and gather all necessary credentialing elements to process information received from providers to support the credentialing process.


5. Prepare files and appeals to be presented to the Medical Director and Credentialing Committee. Effectively communicate and educate providers and internal departments regarding Credentialing Committee decisions.


6. Ensure systematic data oriented efforts to improve consumer and/or client services. 100% of this job is related to QM activities.


7. Collaborate, coordinate, and communicate across disciplines and departments through various methods of communication.


8. Ensure compliance with HIPAA regulations and requirements.


9. Demonstrate Company's Core Competencies and values held within.


10. Responsible for routine internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly to reduce the potential for recurrence as required by applicable state and federal laws, regulations and MPI's Compliance Programs


11. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:
The incumbent works under general supervision in a self-directed and results oriented manner. The incumbent works within established standards and procedures, relying on a broad range of knowledge gained through experience to complete job responsibilities as assigned.

Requirements

JOB REQUIREMENTS (Education, Experience, and Training):

* Minimum high school diploma and/or GED coupled with one (1) year experience in data entry inclusive of maintenance and manipulation of data points. Bachelor's degree in a relevant field is strongly preferred.

* Minimum 1 years' experience in healthcare setting, experience with managed care systems is preferred.

* Communication (written, verbal and listening) and problem solving skills

* Service oriented, flexible and ability to multi-task

* Ability to work independently, effectively and well in both individual and team environments

* Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, Microsoft Word and Excel, etc.

* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

• Medical, dental, and vision coverage (low copay & deductible)


• Life insurance


• Short- and long-term disability


• 401(k) + match


• Generous Paid Time Off


• Paid company holidays


• Tuition reimbursement


• Flexible Spending Account


• Employee Assistance Program


• Summer Hours

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you'd like more information on your EEO rights under the law, please click here.

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