Credentialing Coordinator

Job Details: Level: Experienced, Job Location: Reading

• Wyomissing, PA, Education Level: High School, Salary Range: Undisclosed, Job Shift: Day, MBMS is seeking a self-motivated, organized, Credentialing Coordinator to be responsible for coordinating, monitoring and maintaining the payer enrollment and re-credentialing/revalidation process for our physician groups.

Duties and Responsibilities

Maintains confidentiality of provider information Assists in department training and client onboarding for MBMS Completes provider payer enrollment and re-credentialing/revalidation applications. Monitors provider/organization payer enrollment applications and follows-up as required. Maintains primary source verification of all providers current Medical Licenses, DEA’s, and board certifications.

Maintains copies of Physician Group current licenses, ACR Certification and all required documentation for enrollment purposes. Maintains copies of the providers current malpractice insurance and all educational documentation. Maintains provider contract files by requesting contracts and working with clients to ensure they agree to all terms and conditions.

Maintains Tickets in the Credentialing Department Ticketing System. Collaborate with internal departments, such as CS (Client Service) to ensure seamless integration and coordination of provider enrollment activities and billing. Maintaining credential stream software with provider demographics and all assigned physician groups.

Processing Enrollments and utilizing workflows via Credential Stream for provider enrollment.

Qualifications

High School diploma or equivalent CPMSM or Certified Provider Credential Specialist certificate preferred or minimum two years’ experience. Above average knowledge of basic medical billing and insurance carriers Demonstrated written and oral communications skills Proficient with Microsoft Excel Ability to analyze, interpret and draw inferences from research findings and prepare reports, documentation generation.

Ability to manage confidential information