Credentialing Coordinator

This is an exciting opportunity to join a leading organization dedicated to transforming healthcare. As an Aquent talent, you will play a pivotal role in ensuring the integrity and compliance of our provider network, directly impacting our ability to deliver high-quality health services to clients. Your expertise will be crucial in maintaining robust credentialing standards, fostering strong relationships across departments, and upholding the highest level of trust and accuracy in our operations.

Join a dynamic team committed to revolutionizing the healthcare experience. We are seeking a meticulous and dedicated professional to manage the critical process of provider credentialing. In this role, you will be instrumental in ensuring that all healthcare providers meet the necessary requirements to participate in client health plans, directly contributing to the quality and reliability of our services. You will be at the forefront of compliance, working to maintain the highest standards and build essential relationships across our internal teams.

If you live within 40 miles of our client's office, you will be expected to go into the office 2x/month.

To be considered for this role, you must:

• Be authorized to work in the United States
• Not require sponsorship of any kind for the duration of the assignment
• Be able to work on a W-2 basis. C2C or 1099 is not permitted for this position

Responsibilities:

• Review and screen initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local, and NCQA regulations, guidelines, policies, and standards.
• Conduct primary source verification, collecting and validating documents to ensure the accuracy of all credentialing elements.
• Assess the completeness of information and qualifications relative to credentialing standards and company criteria, while maintaining the confidentiality of all protected health information.
• Identify, analyze, and resolve extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact the ability to credential and enroll practitioners.
• Monitor files to ensure completeness and accuracy, reviewing all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies.
• Prepare and provide information to internal and external customers as appropriate.
• Enter, update, and maintain data from provider applications into the credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses and internal policies and procedures.
• Prepare, issue, electronically track, and follow up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Communicate clearly with providers, internal/external clients, and all staff as needed to provide timely responses upon request on day-to-day credentialing issues.
• Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest developments in healthcare industry regulations and legislation.
• Assist with special projects on an as-needed basis.

Must-Have Qualifications:

• Successful work experience in a credentialing role.
• NAMSS Certification as a Certified Provider Credentialing Specialist (CPCS) or within 2 years of eligibility to certify.
• Experience with CAQH.
• Experience with MD Staff.
• Experience with Google Suite.

The target hiring compensation range for this role is $26.17 to $30.17 an hour. Compensation is based on several factors including, but not limited to education, relevant work experience, relevant certifications, and location

About Aquent Talent:

Aquent Talent connects the best talent in marketing, creative, and design with the world's biggest brands.

Our eligible talent get access to amazing benefits like subsidized health, vision, and dental plans, paid sick leave, and retirement plans with a match. We also offer free online training through Aquent Gymnasium. More information on our awesome benefits!

Aquent is an equal-opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. We're about creating an inclusive environment-one where different backgrounds, experiences, and perspectives are valued, and everyone can contribute, grow their careers, and thrive.

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