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Credentialing Coordinator in Miami, FL at Health Choice Network, Inc.

Date Posted: 10/15/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Miami, FL
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/15/2018

Job Description

Health Choice Network is committed to provide exceptional customer service that exceeds the expectation of those we service. Each and every employee at HCN is expected to possess the ability to inspire confidence, display a constructive attitude, make ethical business decisions, and represent the company well in all aspects of customer service.

POSITION PURPOSE

This position is primarily responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

JOB RESPONSIBILITIES

  • Performs primary source verification within 60 days of receipt of application.
  • Reviews credentialing applications for completeness and accuracy.
  • Prepares for audits; Re-credentials providers every 2 years.
  • Queries the NPDB, ABMS, AOIA, EPLS, Opt-Out, Florida Department of Health, Office of Inspector General and any other necessary sources to verify information on applications and any regulatory primary source verification database.
  • Verifies the following line items, but not limited to: medical staff privileges in writing, the DEA certificate, Educational Background and licensure to practice through the state licensing agency Department of Business and Professional Regulations and AMA Physician Master file.
  • Confirms board certifications and residency trainings.
  • Coordinates with center staff to obtain completed credentialing application along with all requested documentation at the time of credentialing or primary source verification.
  • Maintains accurate and up to date credentialing provider files.
  • Maintains provider credentialing database and responsible for completing data entry credentials.
  • Other duties may be assigned.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED FOR THIS POSITION

  • Knowledge of PC usage, Windows and Microsoft Office applications; Database software; Spreadsheet software and Word Processing software.
  • Knowledge of Healthcare and/or Community Health Center industry and practices.
  • Clear understanding of credentialing process.

EDUCATION, EXPERIENCE AND CERTIFICATIONS

  • 1 year of experience in a healthcare-related position and/or Associate’s Degree or equivalent from two-year college or technical school or equivalent combined experience.
  • Experience working in a Health Care Organization preferred.

Health Choice Network is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations and executive orders regarding affirmative action requirements in all programs.

HCN is a drug-free workplace.