Credentialing Coordinator

Reports to: Care Ohio Operations Manager

Position Type: Part-Time (24-32 hours/week)

Pay: $22 - $25/Hour

Care Ohio, Inc. is a shareholder-owned independent physician organization engaged in healthcare contracting. It contracts with “payers”, i.e., health insurance companies and third-party administrators (TPAs) that manage employer-funded health benefit plans. Care Ohio provides panels of fully credentialed physicians and other healthcare practitioners to health plans. It is accredited by the National Committee for Quality Assurance (NCQA) to provide credentialing services. Care Ohio also partners with a hospital to form a physician-hospital organization (PHO). The PHO contracts with payers for the provision of both credentialed practitioner panels as well as hospital services. In 2020, Care Ohio acquired Cornerstone Alliance, Inc., a non-profit physician organization engaged in similar contractual arrangements. Care Ohio requires an additional staff member, a Credentialing Coordinator to assist its Operations Manager and Credentialing Supervisor with tasks including verification of practitioner credentials, communication with practitioner offices, and other aspects of network maintenance. Prior secretarial, clerical, or administrative assistant work with strong attention to detail and a background in insurance, healthcare administrative assisting, or employee benefit plan administration would be beneficial.

The Credentialing Coordinator will assist with:

• Maintaining the membership database and annual billings of member dues,

• Efficiently processing practitioner membership applications for initial and reappointment, including the

identification of responses that require further review or additional information.

• Maintenance of credentialing files in an orderly fashion incorporating up-to-date information regarding

licensure, DEA registration, certifications, hospital privileges, professional liability insurance, National

Practitioner Data Bank and disciplinary actions, if any.

• Responding promptly to appropriate data requests.

• Maintaining data integrity. All work must be performed with care and discretion, diligently protecting

confidential information from unauthorized or accidental disclosure.

• Attending occasional evening meetings, recording minutes, and assisting with the preparation of

agendas for meetings of the Care Ohio Board of Directors, the Cornerstone Board of Trustees, and the

Care Ohio Annual Shareholders Meeting,

• Assisting with resolution of certain coverage and payment issues that may arise between payers and

participating practitioners, and

• Performing general office work and assisting the Operations Manager and Credentialing Supervisor

with assigned tasks.

The Credentialing Coordinator must possess a working knowledge of Microsoft Office Products including Excel and Word. A high school education is required with an Associates or college degree preferred. Job-appropriate writing, communication, and organizational skills are essential. The successful applicant will be a detail-oriented self-starter with excellent time-management skills, able to organize, prioritize, and multitask to complete a wide variety of tasks. Appropriate office attire and professional conduct must be maintained.

He or she must be able to successfully interface with and effectively communicate with the Care Ohio

Credentialing Staff as well as with Care Ohio officers and board members, medical office managers, health insurance provider relations personnel, physicians and other healthcare practitioners and hospital managed care administrators.

To Apply: Email your resume to [email protected] with “Care Ohio – Credentialing Coordinator” in the subject line.

Pay: $22.00 - $25.00 per hour

Work Location: In person