Credentialing Coordinator

Company: Meritage Medical Network
Location: Elk Grove
Posted on: November 22, 2022

Job Description:

Position Summary:As a key member of the Network Relations Department, serves as the primary point of contact for all incoming calls and inquiries to the department. Provides administrative support to the Network Liaisons while they are out in the field visiting provider offices or are otherwise occupied with meetings and events. Assists with coordinating quarterly physician and network-wide newsletters and ad hoc communications with the provider offices. Assists with the coordination of Network events and meetings. Sets up and maintains network department databases, files and records.Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers in Meritage Medical Network. Responsible for ensuring providers are credentialed, appointed, and privileged withcontracted health plans, and National Committee for Quality Assurance (NCQA) requirements. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Works to develop and maintain a streamlined, efficient and automated process for credentialing and re-credentialing. Works closely with other Meritage staff (e.G., Claims and Utilization Review department staff), to update provider agreements in the Meritage database (Quickcap).Duties and Responsibilities: Maintains a sound and comprehensive understanding of the Network Relations department and staff in order to assist internal and external customers to the department with service and information requests. Maintains a solid understanding of the Meritage Medical Network organization, services and staff and how such services and personnel support network physicians and practices. Answers department telephones, responds to general inquiries, takes messages and refers calls/inquiries to the appropriate Network Liaison, and/or refers calls as necessary to other Meritage staff/departments. Assists with the development of physician and office staff information and education materials for distribution in the field, including the Network Quarterly newsletter, to physician practices. Assists with the preparation and coordination of network physician social events such as the annual mixer as well as Practice Manager social events. Assists with the coordination of Regional Operations Committees and Membership Committee meetings, including but not limited to developing and maintaining committee lists, developing and sending out invitations, save the date reminders, reserving meeting locations, meal coordination, developing and disseminating meeting agendas and materials, and maintaining associated records and databases. Responsible for all aspects of credentialing/re-credentialing providers, to include but not limited to verification of application/documents, mailing of requests for consideration, initial applications, approval, denial, termination letters, tracking license and certification expiration for providers, and accurately loading/maintaining provider information into the Credentialing database. Prepares credentialing files and monthly matrices for presentation to the Membership Committee; responsible for confirming the completeness of information and all documentation prior to presentation. Maintains all of the credentialing documentation up to health plan audit standards and coordinates with health plans for annual credentialing audits. Maintains knowledge of current health plan and network requirements for credentialing providers. Develops, maintains and provides reports from the department database and prepares custom reports, data searches and/or data analysis in response to specific requests by internal and external customers. Audits health plan directories for current and accurate provider information. Drafts credentialing policies and procedures as directed by the Membership Committee and/or Director of the Provider Relations department. Maintains confidentiality of provider information. Consistently demonstrate behaviors, conduct and communications that support Meritages Practices and Values ofAccountability, Diversity, IntegrityandRespectfor others, and will seek to influence these behaviors in others. Continuously endeavors to "raise the bar" of performance and teamwork through a focus onInnovation, Collaboration,EqualityandCompassion. Performs other duties as assigned related to supporting the Network Relations Department and the overall Meritage organization.Minimum Requirements and Competencies: Bachelors degree in a healthcare, business or related field of study; or equivalent combination of education and experience. 1-3 years related work experience, with a minimum of 2 years of current credentialing work experience, preferably in a managed care setting. National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist (CPCS) preferred. Excellent customer services skills with a demonstrated genuine and friendly demeanor. Strong written and verbal communications skills. Detail orientation with the ability to organize and prioritize work and manage multiple priorities with mature judgement. Ability to multi-task and meet deadlines and agreed upon deliverables.Job Type: Full-timeBenefits:401(k)Dental insuranceHealth insuranceVision insuranceSchedule:Monday to FridayEducation:Bachelors (Required)Experience:credentialing: 2 years (Required)Work Location: Hybrid remote in Novato, CA 94949

Keywords: Meritage Medical Network, Elk Grove , Credentialing Coordinator, Other , Elk Grove, California