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Senior Credentialing Coordinator

JOB SUMMARY: This position is responsible for providing coaching, operational, and infrastructure support to an operations team responsible for credentialing and recredentialing of practitioners and facilities whom are currently contracted or wish to be contracted with the Company. This position will research and consult on standard and escalated practitioner and facility credentialing matters.

JOB ROLES AND RESPONSIBILITIES:

1. Assist Team in daily responsibilities to meet team performance goals to include inventory monitoring and reporting.

2. Manage high priority and specialized requests as appropriate.

3. Reviews, analyzes, and reports on individual, team and department data for trends, gaps, and variances from department performance standards.

4. Ensure all credentialing processes are in compliance with company policies as well as the National Committee for Quality Assurance (NCQA) standards in an effort to maintain accreditation.

5. Provides development and coaching to employees on a consistent basis. Feedback is provided in a timely manner and suggestions for improvements are outlined.

6. Create and maintain internal training materials in collaboration with department management and training teams.

7. Leads training efforts of new team members.

8. Leads mentor, audit, and readiness efforts of new team members and those on a performance improvement plan to identify and model best practice.

9. Assists Department with operational tasks associated with credentialing operations.

10. Participates in projects that involve the collection of credentialing applications.

11. Participates in projects, as a subject matter expert that involve system design/re-design related to credentialing operations.

12. Tests all credentialing operations related system(s) design/re-design related to credentialing operations.

13. Serve as a subject matter expert for all credentialing activities performed within assigned area including the education and training of staff extenders on credentialing methodologies and approaches, with an emphasis on operational efficiency and quality optimization.

14. Utilizes knowledge outside of team's standard procedures to increase contextual understanding of processes.

15. Ability to compose and present communications describing tasks and overall context, including existing process guidelines as well as associated risks and controls.

16. Collaborate, coordinate, and communicate across disciplines and departments.

17. Ensure compliance with HIPAA regulations and requirements.

18. Demonstrate Company's Core Competencies and values held within.

19. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.

JOB SCOPE:The incumbent works under general supervision in a self-directed and results oriented manner. The incumbent works within established standards and procedures, relying on a broad range of knowledge gained through experience to complete job responsibilities as assigned. The incumbent exercises independent decision making and discretion on standard and escalated issues concerning applicability as well as to prioritize and balance their workload to ensure efficient and timely work output. The incumbent works collaboratively with other departments and has regular interaction with colleagues internal and external to the department. This job does not directly supervise but provides lead direction to team members as needed, or if the Team Lead is absent or unavailable.

JOB REQUIREMENTS (Education, Experience, and Training):

• Minimum High School Diploma or G.E.D. Bachelor's degree in a relevant field preferred.

• Minimum 2 year of experience in provider credentialing preferred.

• Experience with team member coaching/mentoring or ability to coach/mentor preferred.

• Communication (written, verbal, listening), leadership, problem-solving, and organization skills.

• Ability to engage staff at all levels to work toward unified goals and objectives.

• Ability to prioritize their work and the work of others to meet rigorous productivity goals and standards.

• Ability to present and speak publicly.

• Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, Microsoft Word, and Excel, etc.

• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone.

COMPENSATION:

The salary range for this position is $23 to $26 per hour. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

APPLICATION DEADLINE

We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.

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Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.