Healthcare Coordinator, Healthcare Administration

Job Title

Credentialing Coordinator

Location

Hybrid in Detroit, Michigan

Job Type

Contract

Hours Per Week

40 hours per week

Schedule

Monday – Friday, Hybrid

Pay Range

$24.50 an hour

Work Site

The resource will be required to work onsite two days per week and may work remotely for the remaining three days. Resource must live in the metropolitan area.

Summary

Process practitioner and organizational provider applications for credentialing based on State and Federal regulations and NCQA accreditation standards.

Essential Duties and Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Responsible for the processing of practitioner and organization/facility provider applications for credentialing and recredentialing; requesting primary source documentation, processing documentation requirements, verifying information received, updating information in the system of record, evaluating overall case categorization and reporting findings to the Medical Director and Enterprise Credentialing Committee.
• Resolve inquiries related to credentialing file disposition.
• Provide credentialing status information for group administrators, physicians and their staff, Provider Services, Customer Service and Network Development Inquiries.
• May be designated by the leader to attend Credentials Committee meetings and conduct internal meetings and participate in auditing processes.
• Assist with special projects and job aids as needed.

Education and Experience

• Associate degree preferred.
• Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital business office role and/or credentialing related field required.
• Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing required.
• Knowledge of CAQH required.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other

Skills and Abilities

• Excellent organizational skills with attention to detail required.
• Excellent verbal and written communication skills required.
• Ability to handle and prioritize multiple case files and timelines required.
• Ability to work effectively independently or in a team environment required.
• Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use required.