Credentialing Coordinator
Department:
Quality Improvement
Effective Date:
December 22, 2021
Reports to:
Credentialing Supervisor**
Direct Reports:
None
FLSA:
Non-Exempt
Working Conditions: Normal, no adverse or hazardous conditions.**

R:\HR\Job Descriptions\Credentialing\ Credentialing Manager 4.18
Primary Purpose: The credentialing coordinator is responsible for organizing, maintaining, and
verifying all aspects of the credentialing process for healthcare practitioners based on company Policies
and Procedures, and NCQA standards.
*Principal Duties and Responsibilities (= essential functions):

*
Maintain policies and procedures to meet NCQA guidelines

Retain ownership of Gemini, the CVO used for the credentialing process

Create meeting documents for credentialing and re-credentialing approval

Submit deliverables for the health plan audits and complete any corrective plans as required

Audit Gemini bi-annually to annually

Review all initial apps for accuracy and completeness

Perform credentialing activities for all new physicians for assigned PDT IPAs

Perform re-credentialing activities for all assigned providers due for re-credentialing

Manage credentialing and re-credentialing for assigned HDOs

Query and review of all the required credentialing data sources, including but not limited to primary
source verification, work history, hospital privileges, malpractice claims, OIG, NPDB, Opt Outs, etc

Maintain the database to track all current credentialing information and to update expiring
information

Prepare credentialing information and reports for Quality Information Committee (QIC), including
the reporting of site audits and any adverse provider actions.

Assist with managing current credentialing files for each contracted provider.

Assist with managing and successfully pass credentialing audits with all contracted Health Plans.

Maintain professional and technical knowledge by participating in ICE credentialing committee
meetings.

Takes initiative and is innovative in solving or recommending ways to solve issues and communicate
to company leadership as applicable.

Perform other duties as assigned.

*Job Specifications:

*
Knowledge of Gemini recommended

Minimum of two (2) years credentialing experience required in a Health Plan or IPA environment.

Requires the ability to communicate clearly and effectively to peers, superiors, subordinates,
physicians and others when representing the company.

Ability to multitask, work independently and with minimal supervision.

Ability to appropriately maintain confidentiality.

Requires fast, accurate typing skills and intermediate level computer software competency, including
Microsoft Word, Excel, Outlook, and Knowledge of the following web based queries: NPDB,
CAQH, Breeze, OIG, CMS Opt-Out, etc.

Job Type: Full-time

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