Job Title: Credentialing Coordinator
Location: Hybrid in Detroit, Michigan
Job Type: Contract
Expected Hours Per Week
40 hours per week
Schedule
Monday – Friday, Hybrid
Pay Range $24.50 an hour
Onsite – Tower Building:
The resource will be required to work onsite two days per week and may work remotely for the remaining three days.
Resource must live in the metropolitan area.
Summary
Process practitioner and organizational provider applications for credentialing based on State and Federal
regulations and NCQA accreditation standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1. Responsible for the processing of practitioner and organization/facility provider applications for
credentialing and recredentialing; requesting primary source documentation, processing documentation
requirements, verifying information received, updating information in the system of record, evaluating over
all case categorization and reporting findings to the Medical Director and Enterprise Credentialing
Committee.
2. Resolve inquiries related to credentialing file disposition.
3. Provide credentialing status information for group administrators, physicians and their staff, Provider
Services, Customer Service and Network Development Inquiries.
4. May be designated by the leader to attend Credentials Committee meetings and conduct internal meetings and
participate in auditing processes.
5. Assist with special projects and job aids as needed.
EDUCATION AND EXPERIENCE
1. Associate degree preferred.
2. Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital
business office role and/or credentialing related field required.
3. Knowledge of related state/federal regulations, NCQA, DIFS, MDHHS and CMS standards for credentialing
required.
4. Knowledge of CAQH required.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
OTHER SKILLS AND ABILITIES
1. Excellent organizational skills with attention to detail required.
2. Excellent verbal and written communication skills required.
3. Ability to handle and prioritize multiple case files and timelines required.
4. Ability to work effectively independently or in a team environment required.
5. Intermediate knowledge of Microsoft Word, Excel, Access, PowerPoint, and internet use required.
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