Job Details

Credentialng Coordinator I

Fully Remote • 95-00-Corporate - Asheville, NC 28803

Description

Responsible for provider enrollment with payors to include: perform credentialing and re-credentialing related functions for all Allergy Partners providers on a national and state level with managed care companies, payors, and/or insurance carriers for new physicians and start-up practices. Serves as a resource and liaison to implement and resolve issues related to credentialing.

Responsibilities include, but are not limited to, the following:

• Create and maintain licensing, credentials and insurance records
• Conduct research on updated state and federal regulations and policies
• Help develop internal credentialing processes
• Monitor license and credential expiration dates and advise staff members of required "renew by" dates
• Ensure the Providers and staff members are maintaining compliance with regulatory and accrediting institutions
• Maintain tracking database for all credentialing activities
• Completes provider credentialing and re-credentialing applications, nationwide; monitors applications and follow-up as needed
• Maintain and monitor current state licenses, DEA licenses, malpractice insurance and any other required credentialing documents for all providers
• Continual maintenance of provider files
• Processes applications for credentialing and re-credentialing
• Other duties as assigned

• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.

• Typical Physical Demands Physical demands are moderate with occasional lifting of items weighing approximately 20 – 30 pounds; vision must be correctable to normal range and hearing acuity must be adequate to receive instructions and converse on standard telephone equipment; must have manual dexterity sufficient to operate a keyboard and other standard office equipment. Typical Working Conditions Normal office environment. Occasional evening or weekend work.

Qualifications

EDUCATIONAL REQUIREMENTS:

• High School Diploma or GED required

QUALIFICATIONS AND EXPERIENCE:

• Minimum 3 years' experience in credentialing field
• Ability to meet strict deadlines
• Attention to detail
• Good communication skills
• Knowledgeable in policies, laws and procedures
• Strong computer skills
• Proficiency in database management (if applicable)
• Willingness to work as a team player
• Good organizational skills
• Knowledge of Credential Stream a plus