Managed Care Coordinator

Under general supervision of the Vice President of Managed Care and managed under the Manager of Managed Care, the Managed Care Coordinator obtains, organizes, maintains, arranges, develops, and plans functions in support of the credentialing of physician and non-physician providers with governmental and non-governmental payors and plans. The Coordinator compiles and maintains current and accurate provider data for submission to payors and other internal departments, is familiar with the processes involved in insurance payor credentialing and recredentialing, monitors applications and follow-up as needed, maintains provider files and relationship between TGH and the credentialing vendor, submits requests for information necessary for credentialing or recredentialing, is familiar with CAQH database maintenance, tracks licensure and certification expirations, validates data in internal systems, runs minimum difficulty ad-hoc reports from internal system, maintains NCQA Quality Measure Data, contacts employed physician office sites and payors to validate accurate provider information, ensures that practice/physician demographics are accurate and current in paper and online directories with health plans, agencies and other entities to correct data, assist in coordinating projects and mass mailings. The Coordinator will also assist and actively participate in the maintenance and acquisition of NCQA certification. Essential Functions: Obtains, organizes, maintains, arranges, develops, and plans credentialing of providers. Maintains and strengthen relationships with Health Plans for credentialing. Compiles and maintains current and accurate provider data for submission to payors and other internal departments. Monitors applications and follow-up as needed, maintains provider files and relationship between TGH and the credentialing vendor. Tracks and produces written communication on all internal and external credentialing sites. Maintains and creates NCQA Quality Measure Data reports and other reports. Updates and ensures correct provider credentials in numerous databases. Under general supervision of the Vice President of Managed Care and managed under the Manager of Managed Care, the Managed Care Coordinator obtains, organizes, maintains, arranges, develops, and plans functions in support of the credentialing of physician and non-physician providers with governmental and non-governmental payors and plans. The Coordinator compiles and maintains current and accurate provider data for submission to payors and other internal departments, is familiar with the processes involved in insurance payor credentialing and recredentialing, monitors applications and follow-up as needed, maintains provider files and relationship between TGH and the credentialing vendor, submits requests for information necessary for credentialing or recredentialing, is familiar with CAQH database maintenance, tracks licensure and certification expirations, validates data in internal systems, runs minimum difficulty ad-hoc reports from internal system, maintains NCQA Quality Measure Data, contacts employed physician office sites and payors to validate accurate provider information, ensures that practice/physician demographics are accurate and current in paper and online directories with health plans, agencies and other entities to correct data, assist in coordinating projects and mass mailings. The Coordinator will also assist and actively participate in the maintenance and acquisition of NCQA certification. Essential Functions: Obtains, organizes, maintains, arranges, develops, and plans credentialing of providers. Maintains and strengthen relationships with Health Plans for credentialing. Compiles and maintains current and accurate provider data for submission to payors and other internal departments. Monitors applications and follow-up as needed, maintains provider files and relationship between TGH and the credentialing vendor. Tracks and produces written communication on all internal and external credentialing sites. Maintains and creates NCQA Quality Measure Data reports and other reports. Updates and ensures correct provider credentials in numerous databases. High School Diploma or GED. At least three years experience in credentialing healthcare providers with health insurance companies and other entities. Technical Knowledge, Skills, and Abilities: Strong typing, written and verbal communication skills. Highly organized. Independent worker. Proficient use of Microsoft Office applications including Excel/Word. Prioritization of tasks to ensure critical deadlines are met. Knowledge of CAQH and NCQA requirements and regulations. Proficient use of internet resources. High School Diploma or GED. At least three years experience in credentialing healthcare providers with health insurance companies and other entities. Technical Knowledge, Skills, and Abilities: Strong typing, written and verbal communication skills. Highly organized. Independent worker. Proficient use of Microsoft Office applications including Excel/Word. Prioritization of tasks to ensure critical deadlines are met. Knowledge of CAQH and NCQA requirements and regulations. Proficient use of internet resources.

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