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Credentialing Coordinator

About the Position

The Credentialing Coordinator will be responsible for reviewing and analyzing provider applications and credentialing documents including certificates of education, residency, board certification, eligibility, licensure, professional work history, liability insurance and malpractice history. The Credentialing Coordinator will also update and maintain provider data in the credentialing database, as necessary.

Benefits:

  • Medical, dental, vision coverage
  • 401k w/ company match
  • Life insurance
  • Flexible spending account
  • Paid time-off
  • Professional development reimbursement
  • Annual bonus

Job Function & Responsibilities:

  • Review provider credentialing applications for completeness and performs primary source verification within required timeframes
  • Provide written correspondence to providers and the health plan’s Provider Assessment Committee regarding provider’s credentialing status and or issues
  • Assists with managed care delegated credentialing audits and conducts internal file audits
  • Participates with credentialing and enrollment activities with governmental payers, commercial and managed care payers and networks
  • Correspond with providers, licensing agencies, educational institutions and various regulatory agencies to gather required verifications and information pertaining to credentialing

Skills & Experience: 

  • 3+ years experience in medical staff credentialing with certification. Previous credentialing processing experience within a HMO, PPO, or practice management group preferred
  • Sound understanding of federal and state regulations as they relate to credentialing
  • Intermediate level familiarity with medical terminology, NCQA guidelines, federal contracting requirements, and certifications preferred

 

About Rediclinic:

RediClinic is a subsidiary of Rite Aid Corporation, a Fortune 500 Company. We have nearly 100 walk-in clinics nationwide and partner with some of the nation’s leading Healthcare Systems such as Memorial Hermann Health, Hackensack Meridian Health, Seton Healthcare, MultiCare Health to carry out our mission to provide patients with easy access to high quality, affordable healthcare.

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