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Credentialing Coordinator

Omaha, Nebraska
Job Type
6 Aug 2022
  • Purpose of Job
    • Perform credentialing and re-credentialing duties for Methodist Health Partners including data collection, primary source verifications, and preparation of credentialing files.
  • Job Requirements
    • Education
      • Associate's degree preferred.

    • Experience
      • 2 to 3 years experience working in the managed care area as a credentialing representative, provider relations representative, or in the business office of a physician practice or hospital business office.
      • Working knowledge of the health insurance, managed care industry, its terminology, credentialing procedures, NCQA & URAC guidelines normally acquired through 3 to 5 years experience working for a payor or provider.

    • License/Certifications
      • N/A

    • Skills/Knowledge/Abilities
      • Knowledge of credentialing policies and procedures.
      • Knowledge of credentialing criteria from organizations such as NCQA & URAC.
      • Knowledge of Delegated Credentialing Agreements.
  • Physical Requirements
    • Weight Demands
      • Light Work - Exerting up to 20 pounds of force.

    • Physical Activity
      • Not necessary for the position (0%):
        • Climbing
        • Crawling
        • Kneeling
      • Occasionally Performed (1%-33%):
        • Balancing
        • Carrying
        • Crouching
        • Distinguish colors
        • Lifting
        • Pulling/Pushing
        • Standing
        • Stooping/bending
        • Twisting
        • Walking
      • Frequently Performed (34%-66%):
        • Fingering/Touching
        • Grasping
        • Keyboarding/typing
        • Reaching
        • Repetitive Motions
        • Sitting
        • Speaking/talking
      • Constantly Performed (67%-100%):
        • Hearing
        • Seeing/Visual

    • Job Hazards
      • Not Related:
        • Chemical agents (Toxic, Corrosive, Flammable, Latex)
        • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
        • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
        • Equipment/Machinery/Tools
        • Explosives (pressurized gas)
        • Electrical Shock/Static
        • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
        • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
        • Mechanical moving parts/vibrations
  • Essential Job Functions
    • Essential Functions I
      • Process initial credentialing and re-credentialing applications.
      • Screen practitioners' applications and supporting documentation to ascertain their eligibility.
      • Works within a physician database to maintain provider data, including but not limited to license and DEA expirations and board certification.
      • Present applications to the Credentialing Coordinator and/or Credentialing Chairman.
      • Assist customers with credentialing inquiries.
      • Capture primary source documentation in computer databases.
      • Ensure compliance with applicable laws, regulations, procedures and policies.

    • Essential Functions II
      • Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.
      • Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.
      • Other duties as assigned.
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  • Job Reference: 678877128-2
  • Date Posted: 6 August 2022
  • Recruiter: Methodist Health System
  • Location: Omaha, Nebraska
  • Salary: On Application
  • Sector: Healthcare & Medical
  • Job Type: Permanent