Credentialing Coordinator

Required Education: Associates degree. AND:

• 24 months healthcare experience in credentialing quality assurance risk management medical billing or directly related healthcare experience.

Equivalency/Substitution: Will accept 24 months related experience in lieu of the Associates degree for a total of 48 months related experience.

Skills:

• Knowledge of NCQA and AAAHC credentialing standards
• Knowledge of Medicare and Medicaid credentialing regulations and commercial insurance credentialing.
• Ability to identify problems and discuss with supervisor
• Ability to multitask and complete assignments in a timely manner.
• Ability to work independently and as a team player.
• Excellent communication skills.

Certifications: None

Advertised Working Conditions:

• Physical:
  • Sit for prolonged periods.
  • Communicate effectively and listen.
  • Use of a computer and calculator.
• Environmental:
  • Standard Office Environment.
  • Contact with departments faculty and outside entities.

Why You Belong at the University of Oklahoma:The University of Oklahoma values our communitys unique talents perspectives and experiences. At OU we aspire to harness our innovation creativity and collaboration for the advancement of people everywhere. You Belong Here!

Equal Employment Opportunity Statement:The University in compliance with all applicable federal and state laws and regulations does not discriminate on the basis of race color national origin sex sexual orientation marital status genetic information gender identity/expression (consistent with applicable law) age (40 or older) religion disability political beliefs or status as a veteran in any of its policies practices or procedures. This includes but is not limited to admissions employment housing financial aid and educational services.

Responsible for all aspects of credentialing for providers to include but not limited to coordinating delegated and non-delegated credentialing activities collecting credentialing information from providers performing necessary queries and background checks on physicians developing and maintaining credentialing files performing credentialing activities necessary to maintain accreditation and coordinating with insurance companies and third party payers concerning credentialing.

Duties:

• Initiates and processes provider applications for new providers for the purpose of credentialing and re-credentialing. Performs inquiries from the National Practitioner Data Bank State Medical Board and other entities for the credentialing process.
• Develops an understanding of National Committee for Quality Assurance (NCQA) and Accreditation Association for Ambulatory Health Care (AAAHC) credentialing standards Medicare and Medicaid credentialing regulations and commercial insurance credentialing requirements. Participates in accreditation activities and development of credentialing policies and procedures.
• Develops an understanding of the credentialing processes used by each of provider services contracts and assists with expediting the process. May coordinate third party credentialing site visits as necessary. Coordinates third party credentialing delegation contracting processes.
• Provides credentialing information to IT department electronic billing vendors and any other parties to ensure claims can be sent by the IDX information system.
• Establishes and maintains effective lines of communication with each provider departments and clinics. Provides credentialing information to the billing offices and medical departments in the submission and resubmissions of claims.
• Maintains current files for all providers. Ensures provider files meet NCQA and delegated provider requirements.
• Maintains a central database showing the current credentialing status for each provider for all provider services contracts.
• Participates in medical group committees and teams. May assist with coordinating the Credentialing Committee and Credentialing Liaison Committee meetings.
• Performs various duties as needed to successfully fulfill the function of the position.