[Hiring] Credentialing Coordinator I @Mass General Brigham

Role Description

The Credentialing Coordinator I is responsible for the processing, reviewing, and maintaining provider and facility credentialing and re-credentialing files within department turnaround and quality standards. He/she is responsible for working with the management team to monitor compliance of current workflows, assisting with defining revised workflows, and for distributing the day's assignments in the absence of the manager.

• Enters and updates provider and facility data in credentialing database, PEP, and QNXT while still adhering to input standards, including for the OneCare and SCO lines of business.
• Works with External Credentialing Verification Organization (CVO) on processing Credentialing Information and Reporting, as well as Delegate Credentialing information.
• Maintains required ongoing monitoring and sanctions reporting.
• Coordinates the processing of initial and re-credentialing applications within the established turnaround times while ensuring that Mass General Brigham Health Plan meets all State and NCQA requirements through the HCAS (HealthCare Administrative Solution) streamlined credentialing process.
• Conducts verification of credentialing elements completed by CVO (i.e., license, DEA, board certification, and NPDB) through the use of system resources, and documents the status in the credentialing database and PEP.
• Performs review and analysis of provider and facility credentialing and re-credentialing applications to determine completeness, including notifying providers when their applications are incomplete or missing information.
• Provides representation, assistance, and guidance on the credentialing process during committee meetings.
• Meets or exceeds all department quality standards for all initial and re-credentialing files.
• In the absence of the manager, interacts and responds to inquiries from teammates with specific questions.
• Holds self and others accountable to meet commitments.
• Persists in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Builds strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

Qualifications

• Associate's Degree preferred
• At least 1-2 years of experience in Clinical/Medical Office/Healthcare required
• At least 2-3 years of previous credentialing experience, with at least 1 year in a health insurance environment, highly preferred
• Experience with OneCare and/or SCO highly preferred
• Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Competence in Microsoft Office including Outlook, Excel, and Word.
• Ability to use independent judgment and to manage and impart confidential information.
• Skill in establishing priorities with independent coordination of day-to-day aspects.
• Ability to communicate effectively both orally and in writing.
• Information research skills.
• Ability to handle multiple tasks.

Requirements

• This is a remote role that can be done from most US states.
• This is a full-time Eastern Standard schedule (e.g., 8-4:30 pm or 8:30-5:00 pm ET).
• Remote workdays require a stable, secure, quiet, and compliant workspace.
• Scheduled Weekly Hours: 40
• Employee Type: Regular
• Work Shift: Day (United States of America)
• Pay Range: $17.71 - $25.28/Hourly
• Grade: 2

Benefits

• Competitive salaries and a benefits package with flexible work options.
• Career growth opportunities.
• Comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable.
• Recognition programs designed to celebrate your contributions and support your professional growth.