JOB SUMMARY

The Credentialing Coordinator plays a vital role in ensuring that healthcare providers meet the necessary qualifications and standards to deliver quality care. This position involves managing the credentialing process, maintaining compliance with NCQA standards, and supporting the overall operational efficiency of the medical office. The ideal candidate will possess a strong understanding of managed care, medical terminology, and have prior experience in a medical office setting.

EXPERIENCE

• Previous experience in a medical office or healthcare setting is required.
• Familiarity with managed care processes is preferred.
• Knowledge of medical terminology is essential for effective communication and documentation.
• Experience with NCQA standards is highly desirable.
• Strong organizational skills and attention to detail are critical for managing multiple tasks efficiently.
• Excellent communication skills, both verbal and written, are necessary for effective collaboration with team members and stakeholders.
  Job Type: Full-time
  Pay: $20.00 - $28.00 per hour
  Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible schedule
• Flexible spending account
• Free parking
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Waterloo, IA 5070

· Assist providers with applications, privileges, and malpractice documentation
· Coordinates the third-party payor credentialing and re-credentialing processes for Medical Group Providers, including problem investigation and resolution.

· Coordinates the facility privileging and re-privileging processes for Medical Group Providers, including but not limited to: a. facilitates information collection, b. completes application forms, c. coordinates submission of applications, and d. supports necessary follow-up, problem investigation and resolution

• End-to-end credentialing process of all new and current providers
• Audit files for accuracy and submit for review
• Prepare reports and track credentialing timelines
• Collaborate with internal teams, vendors, and regulatory agencies
• Support onboarding/offboarding and maintain compliance with HIPAA guidelines
• Initiate credentialing and re-credentialing applications for both individual providers and provider groups.
• Maintain accurate and up-to-date records in the credentialing database.
• Collaborate with medical staff to ensure compliance with managed care standards and regulatory requirements.
• Review applications for completeness and accuracy, following up with providers as needed.
• Prepare reports on credentialing activities and outcomes for management review.
• Assist in the development and implementation of credentialing policies and procedures.

Completes the day-to-day processes related to Medical Staff Credentialing of providers.