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The Credentialing Coordinator will be responsible for the effective, accurate and timely manage care credentialing for all clinicians (i.e., licensed independent practitioners and allied health practitioners) in accordance with federal, state and department procedures. Responsible generating accurate reports including the credentialing status and data related to clinician productivity. Maintains up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

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Responsibilities

Completing and processing provider credentialing applications
· Maintains current and accurate credentialing/privileging files for all licensed independent practitioners
· Maintaining knowledge of current health plan and agency requirements for credentialing providers
· Providing credentialing and privileging verifications if applicable
· Notifies manage care plans of all terminations and demographic changes for all licensed individual practitioners (LIPs)
· Audit managed care plans on a monthly basis to ensure that all LIPs are accurately enrolled with all appropriate practice locations
· Complies and maintains accurate monthly reports/rosters of all enrolled/credentialed practitioners; confirming all providers are appropriately enrolled with the correct managed care plans
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day to day credentialing and privileging issues as they arise
Assists with managed care delegated credentialing audits; conducts internal file audits
Utilizes the credentialing database, optimizing efficiency and performs query, report and document generation
Assists in the implementation and maintenance of processes and procedures including regulatory certification guidelines related to physician credentialing

Qualifications

1-2 years of current and relevant credentialing experience, knowledge of medical credentialing and privileging procedures and standards
Ability to efficiently and effectively manage multiple tasks to prioritize needs and meet deadlines
Strong attention to detail
Sound written and verbal communication skills
Ability to maintain confidentiality of information and exercise good judgment and discretion in handling and disseminating information
Ability to research and analyze data and to work independently with minimal supervision

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Responsibilities

Qualifications

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