Credentialing Coordinator

Credentialing Coordinator

Location: Birmingham, AL

Work Schedule: Mostly Remote - after a 2-4 week onsite training period at our downtown Birmingham office, this position can transition to work mostly remote, with occasional onsite days. The successful candidate must reside within a reasonable travel distance of Birmingham.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Training and Development Programs to develop new skills and reach career goals

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Credentialing Coordinator is responsible for credentialing and re-credentialing practitioners, ancillary service providers and allied health professionals to ensure their qualification to participate in VIVA HEALTH’S provider network. The Credentialing Coordinator will serve a primary role in receiving and incorporating provider data appropriately into the provider set-up workflow process. This position will act as a resource for provider data integrity, provider file management and network development.

Key Responsibilities

• Receive, interpret and incorporate Council for Affordable Quality Healthcare (CAQH) provider data into the credentialing, re-credentialing, and provider data auditing process.
• Use CAQH data and credentialing software findings to make credentialing decisions regarding providers.
• Analyze trends in monthly credentialing data to forecast workload for CAQH.
• Communicate with internal departments to ensure quality assurance findings related to providers are reviewed and acted upon accordingly.

REQUIRED QUALIFICATIONS :

• Bachelor's Degree or equivalent experience in credentialing
• 3 years of experience in credentialing
• Ability to analyze and solve problems related to credentialing of providers and facilities
• Proficient in manipulation of data to report statistical information to several of departments
• Ability to work independently, research and resolve processing issues in a timely manner with little to no supervision
• Organized, detail oriented, and skilled at multi-tasking
• Demonstrate excellent customer service skills through written and verbal communication
• Proficient in the Microsoft Office suite of products
• Knowledge of credentialing software, CAQH, CMS, NCQA guidelines, and JCAHO regulations