Olympia, Washington
Credentialing Coordinator Job Opening in Olympia, Washington - Responsible for all aspects of the credentialing and recredentialing processes for the medical providers who are contracted with the PSW network in accordance with policies, NCQA Accreditation Standards, federal and state requirements.
Proactive team player, strong follow through, quick decision making abilities and ability to problem solve.
Strong verbal and written communication skills with customers, supervisors and co-workers.
Strong organizational, time management and prioritization skills:
Self-starter. Ability to set priorities and keep to projected schedules.
Excellent computer proficiency (MS Office ? Word, Excel and Outlook) including being able to effectively maintain written and computer records in accordance with regulatory agencies
Key Responsibilities
Facilitate the comprehensive and required credentialing and recredentialing process including but not limited to: conducting primary source verification, data collection and complete applications on all assigned applicants in accordance with all requirements.
Administer the weekly standard delegation report, maintaining accuracy and clarity on information provided to health plans.
Oversee monthly review of completed files with Medical Directors and executive leadership team in the evaluation and approval process for physicians and associated health practitioners, identifying and researching concerns and/or recommendations.=
Establish and maintain accurate credentialing files for each assigned practitioner.
Demonstrate proactive and positive customer relations in communicating with provider offices and health plans.
Leads credentialing audits by providing requested files, compiling data and working in partnership with auditing vendor.
Serves as lead for ensuring policies are reviewed annually and reflect, as appropriate, changes in state or federal guidelines.
Draft, proof and edit a variety of correspondence and documents. Responsible for accuracy and clarity of final copy.
Develop and maintain filing and indexing systems, recommending and implementing improvements as appropriate.
Required Education and/or Work Experience:
High school Diploma or equivalent
2 years of solid experience in credentialing within a healthcare organization
Preferred Education and/or Work Experience:
Associates degree preferred
CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management)
Job Type: Full-time
Required experience:
Credentialing: 2 years
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