Auditing, Centers for Medicare and Medicaid Services (CMS), Content Management Systems (CMS), Customer Support/Service, Data Quality, Detail Oriented, Disability Insurance, Employee Assistance Plan, File Management, Flexible Spending Accounts, Forecasting, Health Maintenance Organization (HMO), Health Plan, Healthcare, Healthcare Providers, Healthcare Quality, Healthcare Reimbursement, Life Insurance, Microsoft Office, Multitasking, National Committee for Quality Assurance (NCQA), Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Provider Credentialing, Quality Assurance, Regulations, Statistics, The Joint Commission (TJC), Time Management, Training Program, Training/Teaching, Trend Analysis, Tuition Fees, Writing Skills
Credentialing Coordinator
Location: Birmingham, AL
Work Schedule: Hybrid - after a 5-6 month training period that will be completed 100% onsite at our downtown Birmingham office, this position can transition to a hybrid work schedule with a mix of in-office and remote work. The successful candidate must reside within a reasonable travel distance of Birmingham.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nations Best Places to Work by Modern Healthcare.
Benefits
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Healthcare Reimbursement Account
- Paid Parental Leave
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
- Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Credentialing Coordinator is responsible for credentialing and re-credentialing practitioners, ancillary service providers and allied health professionals to ensure their qualification to participate in VIVA HEALTH'S provider network. The Credentialing Coordinator will serve a primary role in receiving and incorporating provider data appropriately into the provider set-up workflow process. This position will act as a resource for provider data integrity, provider file management and network development.
Key Responsibilities
- Receive, interpret and incorporate Council for Affordable Quality Healthcare (CAQH) provider data into the credentialing, re-credentialing, and provider data auditing process.
- Use CAQH data and credentialing software findings to make credentialing decisions regarding providers.
- Analyze trends in monthly credentialing data to forecast workload for CAQH.
- Communicate with internal departments to ensure quality assurance findings related to providers are reviewed and acted upon accordingly.
REQUIRED QUALIFICATIONS:
- Bachelors Degree or equivalent experience in credentialing
- 3 years of experience in credentialing
- Ability to analyze and solve problems related to credentialing of providers and facilities
- Proficient in manipulation of data to report statistical information to several of departments
- Ability to work independently, research and resolve processing issues in a timely manner with little to no supervision
- Organized, detail oriented, and skilled at multi-tasking
- Demonstrate excellent customer service skills through written and verbal communication
- Proficient in the Microsoft Office suite of products
- Knowledge of credentialing software, CAQH, CMS, NCQA guidelines, and JCAHO regulations