Sr Credentialing Coordinator

Manage an assigned territory of providers, completing all commercial delegated credentialing requirements, collection of all government enrollment materials to ensure meeting the targeted employment effective date. This position requires ongoing monitoring to meet effective dates, to avoid claim revenue losses, referral/preauthorization’s issues, and requires continual communication with operations and new providers. Compile and authenticate Commercial Payer and Government Enrollment, Medical Staff, Allied Health applications and waiver requests in compliance with payer and regulatory requirements and accreditation standards. Analyze essential data within the applications and all additional relevant documentation/information to ensure compliance with payer, NCQA, URAC, federal and state regulatory requirements, Medical Staff bylaws and affiliated documents, and TJC standards for initial appointment, reappointment in an independent, efficient and timely manner. Provider/clinic liaison, fielding questions and following file all the way through completion of payer credentialing and facility privileges if applicable. Serve as team lead by organization and delegating workload management for credentialing coordinators. Serve as backup for procedures and processes currently conducted by the Director to include assisting with annual delegated commercial payer audits, generating approval letters and payer enrollment reports, and serving as the technical expert for the credentialing software program and technical NCQA/URAC/CMS and state and federal requirements. Responsible for protection of highly confidential and sensitive information including peer review and HIPAA protected information.