Insurance Credentialing Coordinator

Galveston County Health District

Texas City, TX, USA

Full time

US$44.1-44.1k (annually)

Jan 12

Coastal Health & Wellness is seeking an Insurance Credentialing Coordinator!

This position is responsible for coordinating, monitoring, and maintaining the insurance credentialing and re-credentialing process, and identifying and contracting with new health insurance lines of business for Coastal Health & Wellness Clinics.

We can offer you:

• Excellent Benefits; including an Amazing retirement package, Affordable Medical Insurance, Paid Time Off plans, FREE Life Insurance, FREE Long-Term Disability, FREE Parking and much, much more! 

• Team Oriented Environment

• Salary Rate: $44,096.00

We want you to join our team of professionals and begin a long-term career with us! If you meet the criteria listed below, please apply.

Required:

  • Graduation from an accredited high school or equivalent
  • 3 + years of experience in insurance credentialing and contracting
  • 5 + years related work experience in a clinical setting, preferred
  • 3 + years of experience performing administrative duties to a high-level manager, preferred
  • Knowledge of CAQH/Proview, NPPES/I&A Management System and PECOS preferred
  • Must possess or ability to readily obtain a valid driver’s license issued by the State of Texas for the type of vehicle or equipment operated
  • Department of Motor Vehicle check may be required, if applicable
  • Customer Service Oriented
  • Excellent written and verbal communication skills
  • Proficient in Microsoft Office (Word, Excel, PowerPoint) required
  • Must be willing and able to work evening and weekend hours if necessary
  • Must be in compliance with GCHD Immunizations policy
  • Must be in compliance with ICS training requirements
  • Must pass criminal background check and drug/alcohol screening

An equivalent combination of education and work experience which appropriately demonstrates the knowledge, skills and abilities to perform the above described essential functions will be considered when hiring for this role. 

Traditional Duties

  • Completes all re-credentialing and revalidation for commercial and government requests for individual providers, service locations and organization
  • Retrieve HEIDIS/Quality Measures from contracted insurance payers/plans and maintain a payer quality measure requirement list for management
  • Facilitates all aspects of the credentialing process, including but not limited to new contracts, re-credentialing and monitoring for medical/dental staff and allied health practitioners
  • Obtains appropriate licensure and/or certifications as required and maintains in appropriate database
  • Ensures that insurance contracts are updated due to changes in staffing or other requirements
  • Experience reviewing contract documents and monitoring and communicating any recommendations and/or changes to the appropriate entity
  • Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow up
  • Facilitate the pre-filling, sending, and receiving of accurate and complete credentialing information; tracks and reports progress in credentialing database, performs follow up activities as needed until the enrollment profile is completed
  • Enrolls medical staff and other allied health professionals into active provider networks
  • Retrieve insurance contracted fee schedules and distribute to management and appropriate staff
  • Facilitates relationships with health insurance companies to provide required documentation needed in the application and contracting process for existing and potential new lines of business
  • Reviews potential contracts and submits to Revenue Cycle Manager and Clinic Financial Officer for review prior to submission to Chief Compliance Officer for final review
  • Monitors new and existing provider networks for potential enrollment and expansion
  • Serves as primary point of contact for health insurances companies
  • Maintains listing of current insurance contracts and communicates changes to Reporting Manager

To apply please visit our website www.gchd.org/jobs and fill out our online application. Applications can be submitted by fax to (409) 938-2284, emailed to apply@gchd.org or in person at 9850-A, Suite A-111, Emmett F. Lowry Expressway, Texas City, TX 77591.

No Phone Calls Please

ADA/EEO/DFWP

Our Mission: Protecting and Promoting the Optimal Health and Well-Being of Galveston County

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Galveston County Health District

The Galveston County Health District operates a variety of public health services and two FQHC clinics.

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