Credentialing Coordinator

🔥 0 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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GlobalHealth, Inc.

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2003

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

GlobalHealth, Inc. is a health insurance company that offers Medicare Advantage (Part C) HMO plans, including Chronic Special Needs Plans (C-SNP) and Dual Special Needs Plans (D-SNP), primarily serving beneficiaries in Oklahoma. It provides Medicare and Medicaid-contracted benefit plans with prescription drug (Part D) coverage, supplemental benefits (dental, vision, hearing, OTC allowances), home support services, transportation, fitness benefits, and member/provider portals and tools for enrollment, claims, and care management. GlobalHealth focuses on serving retirees and dual-eligible or chronically ill populations through local agent support, provider networks, and compliance with Medicare quality standards.

📋 Description

• Process applications and credentialing files, checking completeness and accuracy • Obtain primary source verification of provider qualifications, including board certifications, facility affiliations, licensure, certifications, DEA, OBNDD certificates, and malpractice coverage • Query and process primary source verification and accreditation information from NPDB, OIG, SAM, Revoked Medicare Providers & Suppliers, and Medicare Opt Out • Email or fax GlobalHealth Provider Data Forms or UCA applications for initial credentialing and reappointment • Download provider applications and available primary-source-verified documents from CAQH • Prepare credentialing files and submit practitioner and provider information to the Credentialing Committee for timely approval • Maintain and update accurate credentialing files and databases • Communicate with practitioners to ensure records are current and consistent • Assist the Supervisor of Credentialing, leaders, and Executive Credentialing Committee in following proper credentialing procedures • Notify practitioners and providers of Credentialing Committee decisions and renewal dates • Respond to credentialing status requests • Manage, request, and follow up on expirable items such as licenses, certificates of insurance, and board certifications • Save approved documentation to the credentialing drive and maintain provider folder records • Maintain confidentiality of credentialing files and Protected Health Information • Complete work assignments requested by the supervisor • Maintain current desk procedures and reference materials • Perform other duties as assigned

🎯 Requirements

• High School diploma or equivalent required • Three to five years of credentialing experience • Working knowledge of credentialing processes and guidelines • Knowledge of primary source verification and relevant sources • Proficiency with Word, Excel, credentialing databases, Outlook, HAX, and other applications • Knowledge of credentialing forms and required application-processing documentation • Knowledge of CMS, OSDH, and other accrediting agency standards • Strong, accurate data-entry skills • Excellent customer service skills and telephone etiquette • Ability to communicate successfully • Knowledge of practitioner/provider modalities, specialties, and required education • Ability to maintain accurate databases and documentation • Organizational and time-management skills • Ability to analyze situations and use tact and diplomacy to resolve issues • Strong verbal, written, and organizational skills • Self-directed and self-motivated, with analytical, problem-solving, and decision-making abilities • Ability to learn and retain new skills quickly while maintaining accuracy • Alertness, precision, analytical ability, problem solving, memory, communication, creativity, concentration, judgment, imagination, initiative, and persistence • Helpful, collaborative attitude and willingness to learn and support department operations • Reliable and secure internet connection • Ability to maintain confidentiality of business information and PHI under HIPAA and company policy • Must use reasonable and necessary safeguards to protect company records • Some external travel required • This is not a supervisory position

🏖️ Benefits

• Fully remote work environment • No travel percentage is specified in the position overview; however, some external travel is required • Access to affordable health insurance coverage through GlobalHealth