HDO Credentialing Coordinator

Summary

Responsible for collaborating with CVO, credentialing staff and provider services to coordinate, monitor and maintain the credentialing and re-credentialing process for Health Delivery Organizations (HDO).

Duties and Responsibilities

• Coordinates all activities related to network credentialing including, but not limited to application completeness and maintenance for HDOs.
• Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
• Ensures that all facilities meet standards related to quality improvement programs and personnel issues.
• Verifies that providers are accredited by an appropriate accrediting agency before submission for HDO credentialing process and every three years thereafter.
• Oversees preparation of HDO credential files for completion and presentation to MedPOINT’s Credentialing Committee.
• Responds to inquiries from health plans and provider offices/clinics; interfaces with internal and external customers on day-to-day credentialing issues as they arise.
• Optimizes efficiencies with document generation and reporting.
• Coordinates primary source verification process for HDOs with Gemini Diversified Services (CVO).
• Enters primary source documentation in home grown credentialing database.
• Participates in credentialing committee meetings (monthly and ad hoc).
• Collects and verifies quarterly provider rosters from HDOs.
• Assists with P & P development in accordance with NCQA guidelines for HDO credentialing.
• Contributes information to any corrective action plans related to HDOs.
• Assists with non-HDO credentialing functions as requested by leadership as time permits.
• Performs miscellaneous job-related duties as assigned and requested.

Minimum Job Requirements

High school diploma or GED; at least 1 year experience with hospital medical staff or managed care credentialing including HDO processing.  NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing the above certification highly preferred.

Knowledge, Skills and Abilities Required

• Strong written and oral communication skills.
• Excellent presentation and analytical skills.
• Ability to analyze, interpret and prepare reports.
• Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher.
• Knowledge of all aspects of credentialing including HDO Credentialing.
• Ability to multitask and work well as a team.
• Ability to work independently and productively in a remote environment.
• EZ-CAP® knowledge a plus.