Provider Credentialing/Contract Coordinator – Health Plan Job

Children's Health - HMO Careers

Job Number: 51434

Location: Dallas, TX

Date Posted: 2-23-2017


Position Summary

Responsible for coordinating all aspects of the credentialing and primary source verification process for practitioners and health delivery organizations according to CMCHP policy and procedures.

Essential Duties and Responsibilities

  • Process initial and re-credentialing applications from providers, per policy.
  • Manage and perform analysis of data, identify discrepancies, and resolve within 5 days.
  • System wide subject matter expert and database administrator
  • Complete data entry of applications, reviewing them for errors prior to turning in the provider files for quality review, meeting departmental requirements.
  • Maintain database integrity through ongoing review, analysis and reporting.
  • Maintain regulatory compliance.
  • Work with IS to develop appropriate interfaces between other clinical systems
  • Provides timely reporting on all credentialing database information as needed
  • Conduct primary source verification per policy.
  • Prepare and send out re-credentialing applications, per policy.
  • Complete all requests for re-credentialing packets, per policy.
  • Assist with oversight of delegated entities as needed.
  • Send report to various state plans/departments to identify any providers who haven’t returned their re-credentialing applications or who are past-due for credentialing, meeting departmental requirements.
  • Complete monthly audit of Federal and State exclusion lists and report any adverse findings.
  • Ensure that follow-up occurs for the ongoing state license action monitoring reports, per policy."
  • Assist with coordinating credentialing committee.



  • High school diploma or equivalent required; additional training beyond high school, required


  • Two plus years of credentialing or provider data experience, required.

Specific knowledge, skills and abilities

  • Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
  • Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
  • Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
  • Develop and use collaborative relationships to facilitate the accomplishment of work goals.
  • Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
  • Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
  • Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
  • Effectively manage one's time and resources to ensure that work is completed efficiently.
  • Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
  • Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.
  • Assimilate and apply new job-related information in a timely manner.
  • Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.

Physical demands

  • Light- Exerting up to 20 lbs. occasionally, 10 lbs. frequently, or negligible amounts constantly and may require walking or standing to a significant degree.

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