Credentialing Coordinator

Company Overview: Health Network One (HN1) partners with health plans and providers to modernize how specialty care is delivered and managed, reducing complexity, driving better performance, and improving lives.

With over 30 years of experience, Health Network One advances care in several unique specialties: Total Eye, Sleep Well, Pure Derm and Thrive Therapy. By curating specialty networks and credentialing providers who meet rigorous access and quality standards, we bring together value-based models and clinical expertise to ensure providers thrive, payers succeed, and members receive the high-quality care they deserve.

Position Summary: This position is responsible for the initial credentialing and re-credentialing of network providers, and for the maintenance of provider credentialing files, electronically and on paper. Complies with the HS1 Credentialing Program Description which meets NCQA requirements.

Key Responsibilities

• Receive and process all credentialing/re-credentialing applications according to Company policies and procedure. Maintain accurate and complete records as to the status of each application.


• Data Entry of provider information into the computer system.


• Prepare new provider applications and re-credentialing applications for the Credentialing Committee to review.


• Attends Monthly Credentialing Committee meetings as needed and assist in preparation for meeting.


• Maintain initial and re-credentialing established timelines


• Communicate with providers to update expired credentials, clarify information and other credentialing related issues for initial and re-credentialing.


• Maintain a strict level of confidentiality for all matters pertaining to provider credentials.


• Ensures compliance with and/or adheres to company HIPAA policies and procedures.


• Ensures integrity of data entered into company systems and/or databases.


• Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.


• Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.


• Ability to come to work and work the regular schedule and shift for the position.


• Compliance with all personnel policies and procedures.


• Perform additional duties and related essential duties as assigned.

Qualifications:

• High school diploma or general education degree (GED) College experience preferred.


• Two years or more of managed care credentialing experience.


• Bilingual English/Spanish preferred