GENERAL SUMMARY
Responsible for the daily credentialing/recredentialing process in a health plan or the Credentials Verification Center. Provides staff support to the Credentialing Committee and assists with the verification of credentials for practitioners and facilities.
ESSENTIAL RESPONSIBILITIES
- Responsible for the credentialing and recredentialing activities.
- Initiates process of initial credentialing applications, including but not limited to the review and verification of information submitted by providers by utilization of mail, telephone and database queries.
- Initiates process of recredentialing current physicians in the provider network, including but not limited to the review and verification of information submitted by providers by utilization of mail, telephone and queries.
- Works with Manager to ensure compliance with all State and Federal regulations and standards of the CHC and National Committee for Quality Assurance.
- Prepares information for Credentialing Committee review. Takes minutes for the Credentialing Committee meetings.
- Ensures current maintenance and updating of all associated files and records, both computerized and hard copy.
- Facilitates appropriate problem-solving for phone and/or written inquiries pertaining to the credentialing/recredentialing processes.
- Exercises independent judgment as appropriate to enhance and improve the credentialing process to achieve efficiencies and quality files.
- Responsible for the routine auditing of files to maintain quality and reports key quality indicators to the QI Committee.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Two years effective experience with credentialing function strongly preferred.
- Excellent communication, detailed oriented, organization, interpersonal, and delegation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Newark, DE, US
Organization: 15000 - CHC of Delaware
Schedule: Full-time
Job Posting: 2013-01-23 00:00:00.0
Job ID: 1310263