Credentialing Coordinator - Tallahassee Area

Qualifications: Considering applying for this job Do not delay, scroll down and make your application as soon as possible to avoid missing out. High School Diploma or equivalent, 2 years' experience in managed care credentialing. Knowledge of NCQA requirements and CMS guidelines. Experience with Microsoft Excel and credentialing software preferred. Key Responsibilities: Implement initial credentialing and re-credentialing functions for employed and contracted practitioners. This would include obtaining Medicare, Medicaid and NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites. Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications. Maintain timely and accurate practitioner insurance plan participation status in Athena. Process applications for facility appointment and reappointment of privileges. Review practitioner applications for completion and accuracy and ensure appropriate follow-up; monitor and report on the credentialing progress of each practitioner in Verity Stream credentialing software program. Compile and maintain timely and accurate data entry and periodically revise practitioner data in the Verity Stream credentialing database; maintain practitioner electronic data files on the Managed Care L: Drive; use the CAQH system to submit practitioner data as required by some health plans to credential individual practitioners. Monitor expiring licensure, DEA, board and professional certifications and other expirable documents with practitioners, assisting practitioners with timely renewal as appropriate and escalating to Manager as appropriate. Maintain practitioner CME information, uploading into the CEBroker database. Provide contracted managed care plans with issue resolution. Keep Manager/Lead informed of potential credentialing or enrollment issues. All other duties assigned.