Credentialing Coordinator II
One Call Medical, Inc.

Job Info

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Credentialing Coordinator II

We're looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together. These core values embody our diverse and inclusive culture and help us live out our mission of "getting people the care they need when they need it." Over the last 30 years, our company has established itself as the market leader in managed care for the workers' compensation industry. We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.

Salary Range: $19.04 - $28.56Hourly

This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $19.04 - $28.56Hourly

Benefits Summary:
In return for your commitment to our company's mission, we offer a vast array of benefits to help support the whole you.

• Opportunities to work from home
• Competitive wages with opportunities to earn annual merit increases
• Paid development hours to use for professional and community development!
• Generous paid time off, 8 company holidays, and 2 personal days per year
• $1,000 Colleague Referral Program
• Enterprise Recognition Program rewarding colleagues for their extraordinary work
• Exclusive discounts on travel, activities, and merchandise via work discount program
• Colleague Assistance Program that provides free counseling and financial services
• Tuition Reimbursement Program including certifications
• Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions
• Medical, dental, and vision insurance
• Pre-Tax FSA and HSA health savings accounts
• 401(k) matching
• Company paid life insurance
• Company paid short term and long-term disability
• Pet Insurance
• Healthcare concierge
• The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.

JOB SUMMARY:

The Credentialing Coordinator is responsible for ensuring that the Initial Credentialing and Recredentialing applications are complete within their assigned product line. They are responsible for maintaining current credentials and monitoring receipt of Recredentialng applications for assigned products, reaching out to providers as needed. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and laws relating to credentialing.

Credentialing Coordinator II

Typically requires a minimum of 3 years of experience performing hands processing applications, data entry, and Primary Source Verification in credentialing or background checking process.

Works on problems of moderate scope participating in strategic planning and analysis of situations or data requiring review of a variety of factors.

Answers and responds to complex questions and inquiries via telephone and electronic messaging systems utilizing established procedures.

Ability to effectively provide communication on issues or complex information to a wide audience based on knowledge.

Analysis of applications to ensure completion and accuracy

Establish application readiness for presentation to PQC.

Recredentialing application collection

Interaction with Credentialing and Legacy Systems

Priority Appeals

G GENERAL DUTIES & RESPONSIBILITIES:

CREDENTIALING: 40%

Responsible for gathering and performing a detailed and thorough review to include basic level analysis to ensure that all documents have been received in support of a complete Initial Credentialing or Recredentialing application.

Assembles electronic files and prepares credentials file for submission & processing and next level evaluation.

Follow up with provider/applicant for missing information while tracking for completion. Review of the application prior to expiration of credentialing/network membership to ensure all credentials are current.

Creates the appropriate cycle credentialing effort in the corresponding system to initiate the credentialing verification process.

Uniformly apply clearly defined credentialing protocols to all providers.

COMPLIANCE: 30%

Track, verify, and document expirables/current credentials using acceptable verification sources to ensure compliance with accreditation and regulatory standards.

Tracks and obtains documents and applications from providers prior to recredentialing expiration in compliance with our payer contracts, One Call policies and procedures, and state or federal regulations.

Maintain credentialing expirables for all current network providers, for assigned product line(s).

Manage and maintain continuing medical education records for practitioners/providers.

ADMINISTRATIVE: 30%

Data entry and updates to confirm Provider credentialing records that may feed into supporting product line systems; ensure electronic filing of confidential documentation.

Maintain credentialing database and continuous, consistent data integrity to ensure that accurate and current information is available to all systems and departments.

Support to ensure that rosters and supporting documents are loaded in the applicable system during any type of credentialing process.

Complete outreach to providers in accordance with the outreach schedule both telephonically and electronically. Support in processing items received in the delegation queue and respond to inquiries

Support to ensure that rosters and all requested documents are received within an appropriate time frame, including confirmation of content requirements met, and logging of roster data into the appropriate system(s) for assigned products or regions.

EDUCATIONAL AND EXPERIENCE REQUIREMENTS:
High School diploma required. Some college preferred.
Healthcare Industry experience with focus on provider credentialing/enrollment preferred. Comparable application and data processing experience will be considered.
Experience with computer systems required, including web-based applications and Microsoft Office applications which include Outlook, Word, Excel, PowerPoint, and PDF

GENERAL KNOWLEDGE, SKILLS & ABILITIES:

General knowledge of the U S Healthcare system and workers compensation industry.

Ability to express thoughts clearly, concisely, and effectively both verbally and in writing. Excellent verbal and written communication skills as well as listening skills and reading and writing comprehension to technical and non-technical audiences of various levels within the organization (e.g., executive, management, individual contributors).

Excellent problem solving, time management, and work prioritization skills.

Requires proficient negotiation skills and tactics, both written and verbal.

Self-starter with experience handling high work volume and multiple projects.

Ability to establish and maintain positive relationships with internal and external customers and be a team player.

Ability to think and work effectively in a high-pressure environment. Comfortable with change and possesses the ability to switch tasks and priorities seamlessly. Ability to adapt behavior in response to new information or changing circumstances. Is open to change and new information, ideas, methods, or approaches. Work and collaborate effectively and adjusts to original objective or plan to allow for the best possible results.

Demonstrates active listening and gives full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, not interrupting at inappropriate times, understanding the implications of new information for both current and future problem-solving

Must be able to successfully maintain multiple projects simultaneously, manage and meet multiple deadlines, be detail-oriented, and possess strong organizational skills.

Maintains compliance with One Call's established credentialing processes and protocols. Meets client expectations and department timeliness commitments. Complies with Accreditation and Regulatory Standards in addition to compliance with State and Federal Accreditation Standards and Regulatory Requirements.

Exercise independent thinking and judgment.

Ethical conduct and the ability to respect and preserve confidential information entrusted in the course of professional duties is necessary. Reveals confidential information only to appropriate parties and in accordance with any applicable law. Maintains confidentiality regarding legal matters, privacy issues, information technology, and data integrity.

Patient and Customer Focused: ability to put yourself in our patient's and provider's shoes. Commitment to Patient safety and Positive Provider Engagement Experiences.

Quality of Work: freedom from errors and mistakes with the ability to consistently meet objectives; high attention to detail.

Basic understanding of the credentialing expirable process preferred.

Clerical office, data entry, e-filing, and customer interfacing/communication experience required (preferably in a healthcare setting).

Value and model integrity and honesty by acting in a just, fair, and ethical manner an encouraging ethical behavior among others. Inspire trust and confidence among stakeholders through reliability, authenticity, and accountability.

Display a credible presence and positive image when representing One Call.

Performs other related duties as assigned.

If local resident in the state of Florida, will scan documents and maintain electronic documents in support of established e-filing system.

Strategic Perspective: understands the position of the organization with a global context. Able to anticipate future trends, consequences, and opportunity-costs, and to map a clear path of acceleration toward strategic opportunities.

Commit to continuous performance and process improvement.

Encourage and facilitate cooperation, trust, and group identity; and builds commitment, team spirit, and strong relationships.

Work collaboratively and relate effectively to others by practicing, valuing, and embracing diversity of individuals, and fostering respect and equity in the workplace.

PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENT:

The Physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.

The employee is occasionally required to stand, walk, and lift objects (up to 10 lbs. weight; up to 4 ft. height).

Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus.

The work environment utilizes florescent lighting; noise level is moderate.

The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.

Ability to work long hours - over eight in a workday, and over 40 in a work week as necessary. Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position.

Please be advised this job description is subject to change at any time.

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