Credentialing Coordinator

The Credentialing Coordinator (CC) works directly with physicians and is responsible for CND Life Sciences physician licensing and credentialing, maintaining physician and payer records in a database including providing support for physician continuing education and continuing assessment documentation as required for physician technical records. The CC obtains all primary source information necessary for state regulatory entities and safeguarding highly sensitive information. The primary responsibility of the CC is to maintain credentialing timelines for relevant agencies, verifying information, meeting annual requirements with accurate records, and collaborating with various stakeholders to ensure compliance with technical qualifications and licensures. This role also works with physicians, pathology, and revenue cycle management (RCM) team to uphold payer regulatory requirements such as continuing education, physicians assessments, and payer requirements to continue providing care to patients.

Job Responsibilities:

• Oversees the end-to-end technical verification and credentialing process for all new and current physicians in a timely and complete manner.
• Prepares and submits license and credentialing applications, enrollment forms, and related documents to insurance companies, government agencies, and other relevant entities in applicable states.
• Ensures that all licensure, insurance, and certification requirements are current for all practitioners.
• Monitor licensing application progress and proactively follow up to ensure timely submissions including follow-up responses.
• Ensures turn-around-time throughout the credentialing process as defined by the Medical Staff Bylaws for each state and follows through on initial and re-credentialing process for all physicians.
• Coordinates and communicates with internal departments, providers, and external entities to obtain required documentation and resolve any issues or discrepancies with licensing documents.
• Researches incidents, malpractice claims, advisory letters/letters of concern etc. and request appropriate follow-up information from practitioner or other sources as indicated
• Performs relevant data entry and maintains a technical record and regulatory compliance database with credentialing information.
• Processes appropriate queries for expired licensure, or other regulatory licensing and credentialing requirement queries and maintains documentation in the database.
• Handles provider inquiries and problems within the scope of job function and keeps clinical leaders apprised of all issues as they occur.
• Other duties assigned as needed.
• Ensures compliance with regulatory standards, licensing boards, insurance companies, and organizational requirements.
• Maintain and update the credentialing database with accurate provider information, including licenses, certifications, and malpractice insurance.
• Regularly audit and review provider credentials to ensure compliance with organizational and regulatory standards and identify areas for improvement.
• Keep abreast of changes in credentialing requirements, industry regulations, accreditation standards, policies and procedures, and update internal processes accordingly.
• Liaise with internal teams, such as HR, Quality, and Pathology Operations, to ensure alignment of credentialing processes with organizational policies and requirements.
• Obtains primary source and other verifications in accordance with established guidelines.
• Communicate with external stakeholders, including providers, insurance companies, and healthcare facilities, to resolve any credentialing-related issues.
• Assist with the development and implementation of credentialing policies and procedures to enhance efficiency and accuracy.
• Foster positive working relationships with providers, ensuring clear and effective communication throughout the credentialing process.
• Provide support for and documentation of continuing education.
• Maintain reports and records of monthly physician assessments for technical files in close coordination with Pathology Operations team.
• Generates data analytics reports as needed related to physicians and monthly Quality tracking, including status updates per organization policy.
• Identifies areas of improvement related to credentialing, physician compliance and database management.
• Other duties assigned as needed.

Knowledge, Skills & Experience:

• Proven experience in medical credentialing, licensing, or provider enrollment within a healthcare or life sciences organization
• Familiarity with credentialing requirements of regulatory bodies, insurance companies, and healthcare facilities.
• Strong understanding of medical terminology, licenses, certifications, and privileging processes.
• Knowledge of HIPAA regulations and healthcare compliance.
• Demonstrated problem solving skills and adaptability to be successful in a fast-paced, results orientated, changing environment.
• Excellent attention to detail and organizational skills.
• Proficient in using credentialing software and databases
• Effective communication (both verbal and written) and interpersonal skills, preferred experience working with physicians.
• Must be reliable, responsible, and accountable for work performed.
• Ability to work independently and as part of a team, prioritizing tasks and meeting deadlines in a multi-functional task environment.
• Strong problem-solving and decision-making abilities.
• Must have meticulous attention to detail, organization, and excellent time management skills.
• The ability to handle sensitive, confidential information.
• Must be able to establish daily work priorities and work efficiently to contribute to the successful overall maintenance of the credentialing process.
• Provides optimal customer service to meet the organization's expectations.
• Ability to exercise of a high degree of independent judgment in response to complex and sensitive licensing and credentialing issues, decision making and discretion.
• Ability to use independent decision-making processes and handles assigned duties in a meaningful and confidential manner with minimal supervision.

Education, Certifications & Licensures:

• A minimum of an associate degree in healthcare administration or a related field is required
• Bachelor's degree in healthcare administration, business administration, or science related field (or equivalent experience) is preferred.
• Certified Provider Credentialing Specialist (CPCS) certification a plus

Other:

• This position is based at the Company's Scottsdale, Arizona headquarters with the expectation of performing work on site, in-office a minimum of 3-4 days per week.
• Ability to use copiers, fax machines, and PDF scanners to keep inventory and ordering records. Visual acuity and analytical skill to distinguish sufficient detail.
• Must possess the ability to sit or stand for long periods.
• Must possess the ability to perform repetitive motion.