Credentialing Associate

General Summary of Position
Coordinates, monitors, and maintains the credentialing/recredentialing activities of all practitioners and facilities/organization providers in accordance with established credentialing standards set forth by the National Committee for Quality Assurance (NCQA) and state/federal regulatory body.\r\rWe recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.
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Primary Duties and Responsibilities

Assists Sr. Credentialing Associate with external oversight audit of delegated provider groups.

Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.

Develops and maintains a close working relationship with the MedStar Managed Care Division, network providers, and delegated groups to ensure efforts are coordinated in credentialing.

Participates in multidisciplinary quality service improvement teams, meetings and on committees and represents the department and facility in community outreach efforts.

Performs other duties as assigned.

Tracks and monitors the status of incoming/outgoing applications in the credentialing application log. Oversees the credentialing/recredentialing activities for all contracted network providers and facilities including, but not limited to, entering provider data into the credentialing database, scanning and emailing electronic credentialing files to contracted C.V.O., and processing returned verifications.

Updates credentialing database with current licensure and malpractice insurance information. Scans and attaches updated license/certificates to provider records in the credentialing database.

Works closely with the Sr. Credentialing Associate on preparing provider and facility/organizational files for quarterly, or as needed, credentialing committee meetings. Attends the meetings.

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Minimum Qualifications
Education

• Associate's degree required or
• High School Diploma or GED equivalent plus an equivalent combination of education and related experience required and
• Bachelor's degree in Business or Healthcare Administration preferred

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Experience

• 1-2 years 2 years credentialing experience in managed care, governmental credentialing, payor relations or provider relations including experience working for an HMO, PPO or MCO plan. required or

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Licenses and Certifications

• No special certification, registration or licensure required. required

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Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills.
• Strong organizational, interpersonal, and critical thinking skills.
• Ability to analyze and evaluate credentialing data.
• Must be able to multi-task and pay meticulous attention to detail.
• Proficient in Microsoft Office applications (Word, Excel, Outlook, and PowerPoint).
• Credentialing software experience required.

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This position has a hiring range of $23.19 - $40.61
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