Credentialing Coordinator

CCI Health Services was founded in 1972.  As a 501c (3) non-profit organization that brings high-quality and affordable healthcare to every patient during all stages of life, we are also a diverse and inclusive workplace grounded in community.  As a Federally Qualified Health Center (FQHC), our mission is to lead the way to a more equitable healthcare system for everyone.  Located in the DC Metro area, CCI seeks to hire professionals who are passionate about health care.  Additionally, CCI Health Services:  

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  Has 7 health center sites in underserved communities throughout Prince George’s and Montgomery Counties serving over 34,000 patients. 

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  Oversees several federal, state, and county contracts and/or grants that focus on clinical operations, patient outcomes, and access to care and services. 

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  Provides health assessments for refugees, asylees, and special visa holders for the state of Maryland.  The program currently sees around 2,100 patients on an annual basis. 

Position Summary:

Key Functions & Responsibilities:

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  Maintain provider database/spreadsheet to ensure that all healthcare providers are licensed, and properly credentialed according to regulatory guidelines. 
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  Process initial and reappointment credentialing applications, including verifying healthcare provider information and licensing, National Practitioner Database (NPD) and other required documentation ensuring that all regulatory requirements are met. 
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  Coordinate with medical staff personnel to ensure that contract providers and allied health professionals are properly licensed and credentialed. 
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  Track provider certifications, licensure expiration dates and other expirable documentation, ensuring that all healthcare providers maintain current credentials and are in compliance with regulatory standards. 
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  Adhere to department policies and procedures including timely delivery of completed work and use of resources. 
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  Establish and maintain data entry in Credentialing for Affordable Quality Healthcare (CAQH). 
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  Maintain good rapport and professional communication with Health Plan Representatives. 
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  Support provider enrollment staff with Medicare, Medicaid, and commercial insurances for Maryland. 
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  Communicate with healthcare providers and external agencies regarding licensing and credentialing requirements and ensure ongoing compliance with regulatory guidelines. 
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  Work with physicians, professional staff and physicians' office staff to acquire necessary materials and information. 
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  Support Provider Enrollment Specialist with insurance updates and enrollment. 

Minimum Qualifications:

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  High school diploma or equivalent required. 
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  Experience with state, federal, and accreditation entity regulations and requirements related to credentialing and privileges. 
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  Certification in Medical Staff Services (CMSS) or Certified Provider Credentialing Specialist (CPCS) preferred. 
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  Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances 
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  Minimum of 3 years’ experience in credentialing and provider enrollment at a healthcare facility; experience in a Federally Qualified Health Center preferred 

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  Ability to prioritize tasks and work independently. 
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  Excellent verbal and written communication skills. 
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  Strong organizational and analytical skills, with attention to detail. 
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  Knowledge of credentialing software and databases. Why Work at CCI?
• Extensive benefits plan
• Generous PTO Plan
• 403B Retirement Plan + Employer match up to 4%
• Tuition Reimbursement
• Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
• Our providers are insured for malpractice under the Federal Tort Claims Act

** CCI Health Services is an Equal Opportunity Employer **