Job Summary Under the direction of Member Processing & Credentialing Manager, the Payor Credentialing Coordinator performs provider credentialing and re-credentialing services in compliance with Choice Health policies and procedures, the guidelines of the National Committee for Quality Assurance (NCQA), the legal requirements of the NC Department of Insurance, as well as all other applicable State and Federal Laws. Performs provider credentialing and re-credentialing services in compliance with Choice Health policies and procedures, the guidelines of the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), the legal requirements of the NC, SC, & VA Department of Insurance, as well as all other applicable State and Federal Laws. Responsible for creating and maintaining provider credentialing files, performing primary source verification on all credentials, and querying the National Practitioners Data Bank for all Choice Health and NHMG providers. Prepares for and participates in Choice Health Credentialing Committee meetings. Prepares and maintains Credentialing committee minutes. Acts as liaison with the Choice Health Medical Director on all Credentialing related issues. Assists Choice Health Director of Operations and Member Processing & Credentialing Manager with the development and implementation of Credentialing policies and procedures. Ensures maintenance of Choice Health physician credentials with contracted managed care organizations and insurance companies. Provides support to physicians and practice manager in the application and credentialing process and acts as liaison with managed care organizations, self-insured businesses, insurance companies and Choice Health members. Promotes improvements in the medical management of chronic diseases, and preventive services to Choice Health providers. Come join a remarkable team where quality care meets quality service, in every dimension, every time. #JoinTeamAubergine #NovantHealth Let Novant Health be the destination for your professional growth. At Novant Health, one of our core values is diversity and inclusion. By engaging the strengths and talents of each team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants from all group dynamics to apply to our exciting career opportunities. Responsibilities It is the responsibility of every Novant Health team member to deliver the most remarkable patient experience in every dimension, every time. + Our team members are part of an environment that fosters team work, team member engagement and community involvement. + The successful team member has a commitment to leveraging diversity and inclusion in support of quality care. + All Novant Health team members are responsible for fostering a safe patient environment driven by the principles of "First Do No Harm". Qualifications + Education: High School Diploma or GED, required. 4 Year / Bachelors Degree, preferred. + Experience: + Minimum of two years’ experience in performing credentialing services either for a medical facility, physician office, managed care company, insurance company, or billing department, required. + Three years of experience in healthcare with a clinical focus in medical/surgical nursing; experience in working closely with physicians and other clinicians; experience with clinical data, preferred. + Licensure/Certification: CPCS, preferred. + Additional Skills (required): Proficiency in computer word processing, spreadsheets and database applications. Effective verbal, non-verbal and written communication skills. Skills in establishing and maintaining effective relationships with Senior Management and Leaders within Novant Health, physicians, practice management, and insurance/governmental agency representatives. Strong organizational skills, ability to adhere to deadlines and protocols. Ability to work under pressure and react calmly and effectively in difficult situations. Ability to learn and maintain knowledge of applicable governmental regulations and protocols. Ability to perform in a fast-paced, multi-task environment with flexibility as needed. Ability to be a team player and take initiative. Ability to work under deadlines and heavy workloads. Ability to work with all levels of healthcare personnel from top management to entry level clerks throughout the organization. Ability to take action on a suggested approach within guidelines of standards and procedures. Ability to be flexible and quickly change priorities is critical. Ability to manage multiple projects and meet deadlines. Job Opening ID 89634