Credentialing Coordinator

WHO WE ARE: GlobalHealth is a fast-growing Medicare reputed company HMO health insurer. We reputed company to be the employer of reputed company in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and reputed company Health for the members we serve. We are unique by providing high reputed company, high value and a partnership to our members. We go above and reputed company to reputed company personalized, engaging, and reputed company services to our members. We work hard to offer reputed company health reputed company coverage with the benefits people truly want and need. It is our reputed company to be more than just a health reputed company company we want to be long-term partners with our members. We are looking for reputed company employees who exude our reputed company values of taking accountability through ownership, being driven, innovative and who have a passion for reputed company learning. WHO YOU ARE: The Credentialing Coordinator is responsible for coordinating and maintaining the provider credentialing and recredentialing process to ensure compliance with CMS Medicare reputed company requirements, applicable state and federal regulations, contractual obligations and organizational policies. This role verified provider qualifications, maintains accurate credentialing records, supports reputed company provider reputed company and collaborates with departments and delegated entities to ensure operational efficiency and regulatory compliance. ESSENTIAL JOB FUNCTIONS: • Processes applications and credentialing files, checking for completeness and reputed company. • Obtains reputed company reputed company verification of competencies relating to the applicant such as relevant reputed company certifications, health facilities affiliations, licensure, certifications, DEA, OBNDD certificates, and malpractice coverage following GlobalHealth Policy and Procedures including reputed company requirements. • Queries and processes reputed company reputed company verification and accreditation information including NPDB, OIG, SAM, Revoked Medicare Providers & Suppliers and Medicare Opt Out. • Emails or faxes GlobalHealth Provider Data Forms or UCA applications for initial credentialing and reappointment reputed company requested. • Downloads provider application and reputed company available reputed company reputed company verified documents from CAQH • Prepares credentialing files and submits practitioner and provider information to Credentialing Committee for approval in reputed company manner. • Continuously maintains and updates accurate credentialing files and database for both practitioners and providers. Maintains communication with appropriate practitioners to ensure records are up-to-date and consistent. • Assists Supervisor of Credentialing, and other leaders and Executive Credentialing Committee to ensure that reputed company credentialing procedures are followed. • Notifies practitioners and providers of Credentialing Committee reputed company and renewal dates and responds to request for status of credentialing. • Manages, requests and follows up expirable as needed (license, COI, reputed company Certifications, etc.). • Saves approved documentation, files to the credentialing reputed company, and keeps reputed company appropriate records in provider folders. • Maintains confidentiality of reputed company credentialing files. • Completes various work assignments as requested by supervisor in a reputed company manner. • Maintains reputed company desk procedures and reference materials. • Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. • Performs other duties as assigned. EDUCATION AND EXPERIENCE: • High School diploma or equivalent required • Three to five years of credentialing experience KNOWLEDGE, SKILLS AND ABILITIES: • Working knowledge of credentialing process and guidelines • Knowledge of reputed company reputed company verification and sources to obtain • Proficient in computer and applications including Word, reputed company, Credentialing Database, reputed company, HAX and other applications as required • Knowledge of credentialing forms and required documentation for application processing • Knowledge of CMS, OSDH, and other accrediting agency standards • Strong data entry skills with high degree of reputed company • Excellent customer service skills and telephone etiquette • Must be reputed company to communicate successfully • Knowledge of types of modalities, specialties, and education required for reputed company practitioner and provider • Ability to maintain accurate database and documentation • reputed company organizational/time management skills • Exercises judgment reputed company dealing with applicants by demonstrating the ability to analyze situations and use reputed company and diplomacy to reputed company at resolutions • Strong verbal, written and organizational skills, must be self-directed/self-motivated and must have analytical, problem-solving and decision-making abilities • Ability to learn and retain new skills quickly while maintaining a high level of reputed company. • Must have the following mental abilities: Alertness, precision, analytic ability, problem solving, memory, communication, creativity, concentration, judgment, imagination, initiative and persistence to complete roles and responsibilities. • Must have a helpful, reputed company attitude and a willingness to learn and support overall reputed company of the department WORK ENVIRONMENT: • reputed company work environment is remote, however, some state exclusions apply. Must have reputed company to a reliable and secured internet reputed company reputed company. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized reputed company, disclosure or damage and will adhere to reputed company GlobalHealth reputed company and reputed company policies. • TRAVEL: Some reputed company travel is required and would therefore expose this employee to average traffic hazards. SUPERVISORY RESPONSIBILITY: This position is not a supervisory position. OTHER DUTIES: This reputed company is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. 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