Credentialing Coordinator

People Icon
Admin
Location icon
Roseville, CA
Contract icon
Full-Time

Company Description:

TeleMed2U, Inc. supplies its patients with real-time access to specialist care providers using secure state -of-the-art, audio-visual technology.

Brief Overview:

The primary role of this position is to assist physicians and support the Credentialing team with preparing and submitting credentialing, recredentialing applications and follow up on the status of applications for Physicians and Payers and keep a detailed log of all tasks. The credentialing office associate will be responsible for supporting all aspects of contracting, credentialing and recredentialing and any other administration duties assigned by management.

Job Responsibilities:

Credentialing Responsibilities:

  • Supports the TeleMed2U Provider Network’s credentialing process for all TeleMed2U clinical providers, in accordance with NCQA, URAC, Joint Commission, delegated contracts and CMS accreditation standards, Federal and State laws, and TeleMed2U’s policies.
  • Assists with the management of TeleMed2U Provider Network’s credentialing applications, to ensure distribution, receipt, processing, and timely management through our credentialing process.
  • Coordinates the management of the expirables process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration.
  • Monitors and reports turnaround times for processing of credentials applications, with continued focus on efficient and timely delivery of a high-quality product, in accordance with TeleMed2U’s Provider Network policy timelines.

Payer Enrollment Responsibilities:

  • Manage CAQH profiles for TeleMed2U’s Provider Network.
  • Prepare and submit spreadsheets to health insurance plans to ensure provider participation.
  • Update various databases to ensure proper tracking of enrollments and update requests.
  • Maintain necessary records of outstanding submissions and requests.
  • Update the company/third party databases with the physician/provider's ID number and start date.
  • Maintain familiarity and stay current with health insurance plans' procedures.
  • Coordinate all managed care credentialing activities to ensure provider participation status. Credentialing activities require substantial contact with outside agencies.
  • Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing.
  • Verify physician/provider information for managed care plans including communication with health plan representative and other staff as necessary.
  • Follow-up with managed care companies to ensure expedient credentialing.
  • Remains current on policies affecting provider enrollment credentials & delegated clients/payers.

Qualifications:

  • 1-3 years of experience in licensing and credentialing preferred, but not required
  • High school diploma
  • Bachelor’s degree preferred or equivalent past medical office experience
  • Medicare and Medicaid enrollment experience preferred

What Will Make You Stand Out:

  • Excellent project management skills
  • Ability to communicate effectively, both orally and in writing.
  • Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Detail oriented
  • Work independently with little supervision
  • Database management skills.
  • Knowledge of medical credentialing and privileging procedures and standards.
  • Knowledge of medical staff policies, regulations, and bylaws and the legal environment within which they operate.

Physical Requirements:

  • Prolonged periods sitting at a desk and working on a computer.

Benefits/Compensation:

  • Competitive Salary
  • PTO
  • Health Benefits (Medical, Dental, Vision)
  • 401(k) plan

TM2U is an Equal Employment Opportunity (EEO) employer and does not discriminate in any employer/employee relations based on race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran’s status or any other basis protected by applicable discrimination laws.

Apply for this Job

Fill out the details below and we will be in touch ASAP.

Personal information

Tell us about yourself

Cover Letter

Insert your cover letter here

CV / Resume

Upload your CV or resume file
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.