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External Applicant Current Associate

Credentialing Coordinator Job in Irving

Job Description

Summary:

Responsible for leading, coordinating, monitoring, and maintaining the credentialing expireables process. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of data within the credentialing database.

• Conducts thorough investigation, research, and primary source verification of all expireables.
• Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow-up.
• Prepares and sends monthly expireables reports to clients.
• Responds to inquiries from other healthcare organizations, interfaces with internal/ external customers on day-to-day expireables issues as they arise.
• Meets weekly performance metrics which includes: amount of expireables completed and data integrity.
• Utilizes and maintains the credentialing database, optimizing efficiency, and performs queries, reports, and document generation.
• Monitors the initial, reappointment, and expireables process for practitioners, ensuring compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, Federal/State), bylaws, policies/procedures, and delegated agreements
• Maintains strict confidentiality of all data and information.
• Performs miscellaneous job-related duties as assigned.

Requirements:

• High School Diploma or GED
• Minimum of at least one (1) year experience related to hospital or managed care credentialing.
• Certified Provider Credentialing Specialist (CPCS) preferred

Work Type:

Full Time