Are you looking for an opportunity to join a team that makes a difference in your community? Do you want to work in a fast-paced environment where each day presents a new challenge?

If the answer is yes, opportunity is here, and the time to act is now. Apply today!

JOB SUMMARY:

As the Credentialing Coordinator, you are a critical member of the Carolina QuickCare/Lowcountry Urgent Care team! You will work directly with our Director of Clinical Services and CEO Managers to assist in the processes behind the credentialing of our Providers. The Credentialing Coordinator will obtain, organize, maintain and verify all aspects of the process, and assist in ensuring all necessary documents are routed to the Credentialing department in a timely and efficient manner. This will work with the various agencies required to provide continued support in their credentials as well as Medical Malpractice insurance. They will also maintain current documentation on all providers. You will assist with tracking the expiration of certifications to maintain up to date files and assist providers with inquiries.

To be successful in this role you should ensure currency and accuracy of all information. Preferred candidates will be reliable, energetic and have excellent people skills.

The primary responsibilities of the Credentialing Coordinator include:

• Assist providers with completion of credentialing and re-credentialing applications.
• Forwarding of new applications to the Credentialing department in a timely manner.
• Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing.
• Maintain the credentialing database and ensure up-to-date information is obtained at all times.
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection of all required renewal certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files with Credentialing department.
• Prepare and scan credentialing/re-credentialing files and other credentialing documentation into software.
• Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
• Work with insurance company to ensure Medical Malpractice coverage is in place for all providers according to the individual practicing state requirements.
• Process provider terminations with Credentialing department and Medical Malpractice coverage.
• Audit Disciplinary reports, OIG reports, and other reports as required and initiate the formal complaint procedure when applicable.
• Assist with annual delegated credentialing audits and National Committee on Quality Assurance (NCQA) audits

Our ideal candidate for this position will possess:

• Associates Degree preferred. High school diploma required.
• Certified Professional Medical Services Management (CPMSM) or Certified Professional Credentialing Specialist (CPCS) certification highly desired, but not required.
• Minimum of two (2) years credentialing experience strongly preferred.
• Experience with CAQH (Council for Affordable Quality Healthcare) database and application process.
• Working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards also preferred.
• Health plan experience preferred.