Managed Care Credentialing Coordinator

Our patients are our number one priority! We're committed to giving children back their childhood!

Job Posting Title:

Location:

Additional Posting Details:

Monday - Friday

7 a.m. - 5 p.m.

Hybrid -Remote

Job Description:

Duties/Responsibilities

• Assist leadership in the development, planning, implementation, review and revision of managed care credentialing processes, forms, related policies and procedures with regard to credentialing to stay current with Health Plans practice as well as accrediting and regulatory agency requirements (i.e., NCQA); maintain a working knowledge of such documents and keeps the medical staff updated on all changes

• Facilitate, coordinate, prepare, monitor, maintain and implement all of the credentialing functions for medical staff and advanced practice professionals, in a timely manner, such as: managed care credentialing applications for network participation re-credentialing with health plans, monitoring, including procurement of applications and required supporting documents

• Ensure all expirables are reviewed, obtained, maintained and managed by tracking, documenting: licensures, certifications, specialty certification, and malpractice insurance information prior to their expiration dates and other expirables as required; notify appropriate medical and administrative leadership staff prior to expiration so that required documents can be secured and updated or required intervention or actions can be accomplished in a timely manner

• Originate or collect, update and maintain: all required documentation and records and the managed care medical staff credentialing software databases as appropriate

• Maintain reporting and communication with hospital leadership as to credentialing status of hospital, physician staff, and advanced practice professionals

• Regularly monitor payer websites to ensure accuracy of Scottish Rite for Children and providers in payer online tools (i.e., provider manuals); address with payer to correct any deficiencies 

• Develop annual goals and objectives for the Managed Care Credentialing function in concert with the organization’s strategic plan

• Develop, maintain, and apply working knowledge of relevant federal and state laws and regulations and accreditation standards/agencies and other regulatory requirements (i.e., NCQA)

• Support the General Counsel in handling of legal matters for Scottish Rite, assist with special projects and help maintain files in the Office of General Counsel

• Provide professional support to the management staff in partnership with other support staff

• Attend meetings and take minutes for these meetings as requested

• Assist with miscellaneous duties and special projects as assigned

Required Skills/Abilities

• High school diploma or equivalent required

• Associate degree preferred

• Minimum 2 years of Medical Staff or Managed Care Credentialing Coordinator experience; in a hospital, clinic, or health plan setting is preferred

• Certification through the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM upon hire is preferred.  Otherwise, certification must be obtained within 1 year of hire or 1year of eligibility per NAMSS requirements, as applicable

• Proficient in computer applications (e.g., Windows, Microsoft Office, internet browsers, medical staff/credentialing software databases, etc.)

• Knowledge of standards in managed care credentialing practiced, health plan credentialing requirements, statistics, data collection, analysis and data presentation

• Excellent interpersonal communication, organizational and problem-solving skills