Credentialing Coordinator- Temporary

Purpose

This role will credential practitioners for network participation with PPHP and accurately maintain all provider data within SF to supply the organization with provider data, while ensuring compliance with regulatory, accreditation, legal and company requirements and standards.

35% Analyzes credentialing applications to perform the primary source verification of the appropriate credentials in order for a practitioner to participate in the PPHP networks. Once verified, accepted and approved, determines the appropriate networks and notifies provider.
20% Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status, credentialing, and provider file updates. Direct focus on the provider experience, providing timely resolution dependable follow-up and proactive measures to ensure successful credentialing is achieved. Professional etiquette, communications and sound decision making is required.
20% Maintains the provider file, the Salesforce (SF) inventory workflow system and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and all other provider file maintenance activities.
10% Responsible for identifying, analyzing and resolving immediate and existing provider file issues. Processes provider file inputs in accordance with applicable state laws and departmental guidelines. Verification of provider data and system release entered into the provider file database, ensuring a successful integration with the other corporate systems.
10% Audits all delegated entities on an annual basis to ensure compliance with CMS and NQA standards. 5% Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically.

This role will credential practitioners for network participation with PPHP and accurately maintain all provider data within SF to supply the organization with provider data, while ensuring compliance with regulatory, accreditation, legal and company requirements and standards.

35% Analyzes credentialing applications to perform the primary source verification of the appropriate credentials in order for a practitioner to participate in the PPHP networks. Once verified, accepted and approved, determines the appropriate networks and notifies provider.
20% Responds to external and internal inquiries regarding provider participation eligibility and criteria, participation status, credentialing, and provider file updates. Direct focus on the provider experience, providing timely resolution dependable follow-up and proactive measures to ensure successful credentialing is achieved. Professional etiquette, communications and sound decision making is required.
20% Maintains the provider file, the Salesforce (SF) inventory workflow system and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and all other provider file maintenance activities.
10% Responsible for identifying, analyzing and resolving immediate and existing provider file issues. Processes provider file inputs in accordance with applicable state laws and departmental guidelines. Verification of provider data and system release entered into the provider file database, ensuring a successful integration with the other corporate systems.
10% Audits all delegated entities on an annual basis to ensure compliance with CMS and NQA standards. 5% Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically.

To perform…