Job Summary:
The Provider Enrollment Coordinator III evaluates, analyze and coordinates all aspects of the the onboarding, Credentialing and ongoing monitoring process. Provides integral support to healthcare operations by timely completing onboarding, credentialing and monitoring of the healthcare providers
Essential Functions:
- Oversee various projects related to the Onboarding, Credentialing and Ongoining Monitoring as directed by the Credentialing leadership state and/or federal requirements
- Monitor Prohibited Affiliations and other sanctions/actions for participating, Non participating and delegated vendor providers
- Ensure CareSource meets regulatory and accreditation standards
- Responsible for coordinating and maintaining compliance with the Onboarding, Credentialing and Ongoing Monitoring process
- Maintain compliance with the state, federal, NCQA accrediting organizations related to sanctions/actions monitoring and reporting to appropriate authorities
- Collaborate with Credentialing, Credentialing Committee Chair, Legal, Vendors, Provider Data Integrity, Provider Relations and other departments and business owners related to providers data and actions identified during initial, recred, offcycle review.
- Represent HPLC at various meetings related to the onboarding, Credentialing and ongoing monitoring process
- Guide the development of the onboarding, Credentialing and ongoing monitoring strategies by executing the deliverables and providing regular feedback to leadership
- Maintain leadership role and develop as a subject matter expert related to the onboarding, Credentialing and ongoing monitoring processes
- Present off cycle review of providers with adverse actions to the Credentialing Committee meeting for review
- Maintain confidentiality of provider information
- Cross train and perform standard onboarding, Credentialing and ongoing monitoring processes as needed
Education and Experience:
- Associates Degree or equivalent years of relevant work experience require
- Bachelor’s Degree in health related field preferred
- Three or more years of experience in credentialing is required
Competencies, Knowledge and Skills:
- Proficiency in Microsoft Word, Excel.
- Ability to create, convert, import and export multiple data in various formats for tracking purposes
- Ability to work with FTP sites, electronic files, Cactus, Facets, and other electronic applications.
- Effective oral, written, and interpersonal communication skills
- Cross-functional team skills
- Ability to work independently and within a team environment
- Attention to detail
- Time management skills
- Decision making/problem solvin
- Knowledge of federal, state, NCQA and URAC standards preferred
Licensure and Certification:
- NAMSS certification in credentialing is preferred
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$43,800.00 - $70,200.00
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
-
Create an Inclusive Environment
-
Cultivate Partnerships
-
Develop Self and Others
-
Drive Execution
-
Influence Others
-
Pursue Personal Excellence
-
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.
Please Note :
www.epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.