Credentialing Coordinator I
- This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
- JOB SUMMARY/PURPOSE
- Independently manages all activities associated within the initial and re-credentialing application process and/or the provider enrollment process, which may include primary source verification of licensure, certification and credentials for the purpose of employment, hospital privileges and health plan membership; facility credentialing; provider/facility enrollment with payers; and delegation agreement management. Collaborates with Medical Staff and Samaritan Health Plan offices to ensure accuracy and completeness of files and reduce duplication of credentialing activities. Serves as a system resource for management of system wide provider database.
- DEPARTMENT DESCRIPTION
- The Credentialing Department at Samaritan Health Services credentials new and existing healthcare providers for employment, privileging and participation in Samaritan Health Plans. The credentialing process includes verification, documentation, and approval of a practitioner's credentials and meets the requirements of The Centers for Medicare and Medicaid and our accrediting bodies.
- EXPERIENCE/EDUCATION/QUALIFICATIONS
- High School diploma or equivalent required.
- Two (2) years experience in a position of similar responsibility and complexity required.
- Experience and/or training in theories, concepts, and principles of secretarial science and office management required.
- Experience and/or training in regulatory compliance including The Joint Commission, DNV, NCQA and CMS required.
- Experience and/or training in medical staff structure preferred.
- Experience and/or training in computer applications including Microsoft Word, Outlook and Excel required.
- CPCS certification preferred.
- KNOWLEDGE/SKILLS/ABILITIES
- Computer Literacy - Knowledge of computer software, including Microsoft Office programs and web based applications. Ability to operate applications, enter data, and manipulate and process information.
- Clerical - Knowledge of theories, concepts, and principles of secretarial science and office management. Ability to perform administrative and clerical procedures.
- Credentialing - Knowledge of accreditation, NCQA, medical staff standards and state/federal requirements as they relate to credentialing services.
- Communication - Possess professional verbal and written communication skills for interacting with customers of Credentialing Department.
- PHYSICAL DEMANDS
- Rarely
(1 - 10% of the time)Occasionally
(11 - 33% of the time)Frequently
(34 - 66% of the time)Continually
(67 - 100% of the time)CLIMB - STAIRS
LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
SQUAT Static (hold >30 sec)
SQUAT Repetitive
BEND FORWARD at waist
KNEEL (on knees)
STAND
WALK - LEVEL SURFACE
REACH - Upward
ROTATE TRUNK Standing
PUSH (0-20 pounds force)
PULL (0-20 pounds force)
SIT
ROTATE TRUNK Sitting
REACH - Forward
CARRY 2-handed, 0 - 20 pounds
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
- Rarely
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