Managed Care Coordinator - Tampa

Key Responsibilities:

• Implement initial credentialing and re-credentialing functions for employed and contracted practitioners. This would include obtaining Medicare, Medicaid and NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites.
• Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications.
• Maintain timely and accurate practitioner insurance plan participation status in Athena.
• Process applications for facility appointment and reappointment of privileges.
• Review practitioner applications for completion and accuracy and ensure appropriate follow-up; monitor and report on the credentialing progress of each practitioner in Verity Stream credentialing software program.
• Compile and maintain timely and accurate data entry and periodically revise practitioner data in the Verity Stream credentialing database; maintain practitioner electronic data files on the Managed Care L: Drive; use the CAQH system to submit practitioner data as required by some health plans to credential individual practitioners.
• Monitor expiring licensure, DEA, board and professional certifications and other expirable documents with practitioners, assisting practitioners with timely renewal as appropriate and escalating to Manager as appropriate.
• Maintain practitioner CME information, uploading into the CEBroker database.
• Provide contracted managed care plans with issue resolution.
• Keep Manager/Lead informed of potential credentialing or enrollment issues.
• All other duties assigned.

Qualifications:

• High School Diploma or equivalent, 2 years’ experience in managed care credentialing.
• Knowledge of NCQA requirements and CMS guidelines.
• Experience with Microsoft Excel and credentialing software preferred.