Credentialing Coordinator

We are seeking an experienced Credentialing Coordinator for our Provider Relations Department at our Nashville location.

 

The Credentialing Coordinator will be responsible for processing provider applications in an accurate and timely manner; will conduct primary source verifications in accordance with NCQA, state, and CMS standards; and communicating with internal staff, providers, and other professional entities in a clear and concise manner to obtain credentialing information.

Responsibilities include:Processing credentialing and recredentialing applications in accordance with health plan policies and procedures to meet NCQA, state, and CMS standards Completing credentialing process on all files within established time frames Identifying missing information and going to appropriate source to obtain; conducting thorough research on internet when applicable Communicating with internal staff members, physician offices, academic entities or other health related organizations in a professional and concise manner Prioritizing work activities and tracking progress on all files Accurate data entry into all relevant databases Maintaining work and file information in a confidential manner Identifying changes in provider demographic information and forwarding to appropriate PR/Load staff for database updates Maintaining file room Filing provider information Special projects when identified Licensure and insurance updates

 

Requirements Include:Associate degree preferred 6-12 months previous credentialing experience in either managed care or hospital setting Working knowledge of NCQA guidelines and primary source verification process Familiarity with HMO/managed care environment and IPA/PHO structures preferred Ancillary credentialing a plus Prior auditing experience desirable Must be detail-oriented Ability to prioritize work and maintain a high level of accuracy Ability to work independently with limited supervision Ability to problem solve Ability to effectively communicate with internal staff and external entities when requesting or providing information Familiarity with Word, Excel, Access, Right Fax Competent/proficient data entry skills Familiarity with conducting internet searches and downloading information

 

HealthSpring offers a competitive salary and a full range of benefits.

 

For more information and to apply 

visit www.myhealthspring.com and complete an application.

All interested candidates must complete an on line application

 

Select Department:  Provider Relations

Select Position: Credentialing Coordinator

Attach resume

 

Include salary history/requirement. No phone calls accepted.

 

HealthSpring, Inc. is an EEO/AA employer.