Delegated Credentialing Coordinator at Mindful Health Solutions in Nashville, Tennessee

Job Description:

Overview

We are looking for a Delegated Credentialing Coordinator responsible for processing credentialing and recredentialing applications and/or enrollments of health care providers. This role will have direct responsibility for the delivery of a quality candidate and onboarding experience that support the company’s mission and values.

Responsibilities

• Reviews applications, prepares verification letters and maintains database
• Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and recredentialing applications
• Must have ability to work with health care acronyms, able to differentiate between provider titles, download the providers applications using the Internet
• Identify any issues or trends and bring them to the attention of management team
• Assist with coordination of audit activity for certifications (NCQA etc.) and third party audits (payors, self-insureds, carriers, etc.) for both initial and concurrent audits for delegated credentialing services; also includes monitoring program compliance with contractual terms and effective enforcement of operational provisions
• Build knowledge base for payer requirements and forms.
• Tracks license, and professional liability expirations for appointed providers.
• Completes provider credentialing and re-credentialing applications for escalated cases; monitors applications and follows-up as needed.
• Maintains appointment files and information in credentialing.
• Provides excellence in customer service for internal and external customers when handling communications, whether oral or written.
• Other duties as assigned

Qualifications

• Minimum of 2 years credentialing experience
• Delegated credentialing experience and knowledge on the payor side or provider side required.
• Good understanding of the credentialing process
• Capable of successfully completing credentialing applications with limited supervision
• Ability to maintain confidentiality, work with deadlines and manage multiple priorities.
• General understanding of medical staff policies, regulations, and bylaws and the legal environment within which they operate.
• Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products.
• Detail Oriented, organized, and able to multi-task on critical workflows
• Tech savvy and able to work in