HDO Credentialing Coordinator

Summary

Responsible for collaborating with CVO, credentialing TMs and provider network operations contracting team to coordinate, monitor and maintain the credentialing and re-credentialing process for Health Delivery Organizations (HDO).

Duties and Responsibilities:

1. Coordinates all activities related to network HDO credentialing including, but not limited to application completeness and maintenance for HDOs.
2. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
3. Ensures that all facilities meet standards related to quality improvement programs and personnel issues.
4. Verifies that providers are accredited by an appropriate accrediting agency before submission for HDO credentialing and recredentialing processes.
5. Oversees preparation of HDO credentialing/recredentialing files for completion and presentation to MedPOINT’s Credentialing Committee.
6. Responds to inquiries from health plans and potential HDO locations; interfaces with internal and external customers on day-to-day credentialing issues as they arise.
7. Optimizes efficiencies with document generation and reporting.
8. Establish Health Delivery Organization (HDO) material timelines and ensure that cadenced documents are received.
9. Coordinates primary source verification process for HDOs with Gemini Diversified Services, MedPOINT’s current Credentialing Verification Organization (CVO).
10. Enters primary source documentation in home grown credentialing database and/or symplr once implemented department wide.
11. Participates in MPM credentialing committee meetings (monthly and ad hoc).
12. Collects and verifies quarterly provider rosters from HDOs.
13. Assists with P & P development in accordance with NCQA guidelines for HDO credentialing.
14. Ensures that correct information regarding HDOs is documented on annual health plan delegation documents.
15. Assists with P & P development in accordance with NCQA guidelines for HDO credentialing.
16. Contributes information to any corrective action plans related to HDOs.
17. Assists with non-HDO credentialing functions as requested by leadership as time permits.
18. Performs miscellaneous job-related duties as assigned and requested.
19. Adhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration.

Minimum Job Requirements:

• High school diploma or GED.
• Minimum of one year experience with hospital medical staff, health plan or managed care credentialing experience including HDO processing.
• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively pursuing one of these certifications highly preferred.
• Proficiency with Microsoft Office products; primarily Word and Excel 2013 or higher.
• Knowledge or all aspects of credentialing including HDO Credentialing.
• EZ-CAP, Gemini G1 knowledge a plus

Skills and Abilities:

• Excellent presentation and analytical skills.
• Strong written and verbal communication skills.
• Ability to analyze, interpret and prepare reports.
• Ability to multitask and work well as a team.
• Able to work independently and productively in a remote environment.

Salary Range:

• $28 - $31 hourly