Symbria

Compensation

Full Description

Overview We are seeking a detail-oriented individual to join our team as a Healthcare Credentialing Coordinator. Your expertise will be essential in providing exceptional service to our clients. Come join us and make a meaningful impact in the healthcare industry! The Healthcare Credentialing Coordinator is responsible for managing the full lifecycle of the credentialing and re-credentialing process for healthcare providers. This includes verifying credentials, preparing and submitting applications, maintaining accurate records, ensuring compliance with payer and regulatory requirements, and serving as a primary point of contact for providers, payers, and internal teams. The role is critical to ensuring that all providers are properly credentialed and able to deliver services without. Responsibilities • Confirm and verify provider credentials, including licenses, board certifications, education, training, work history, and references.• Assist healthcare providers with credentialing and re-credentialing applications for Wisconsin Medicaid, Medicare, and commercial payers, ensuring all required documents are accurate, complete, and submitted on time. • Coordinate the credentialing process for physical therapists, physical therapist assistants (PTAs), occupational therapists, certified occupational therapy assistants (COTAs), speech-language pathologists (SLPs), and other allied health professionals.• Prepare and submit credentialing applications to relevant organizations, insurance companies, and government agencies, maintaining accuracy and compliance with payer and regulatory requirements.• Conduct primary source verification by contacting educational institutions, licensing boards, professional organizations, and previous employers, and maintain thorough documentation of all verification activities.• Maintain up-to-date and accurate provider records in credentialing systems such as CAQH ProView, ensuring attestations, malpractice coverage, licensure, and other required information are current.• Create and maintain CAQH profiles for new providers, update practice locations in ProView, and keep the credentialing tracking report current for internal reference.• Monitor and track expiration dates for licenses, certifications, and insurance policies, proactively notifying providers of upcoming renewals and assisting with the renewal process.• Manage the re-credentialing process to ensure timely renewals and continuous compliance with all payers, state, and federal requirements.• Manage Medicare Part B credentialing for providers through the CMS PECOS system, including completing and submitting CMS-855I applications, linking providers to group practices with CMS-855R, uploading required documentation, and coordinating with Medicare Administrative Contractors (MACs) to obtain PTANs.• Stay current with Medicare enrollment regulations, platform changes, and payer-specific credentialing requirements, and adjust processes accordingly.• Respond promptly to insurance company and payer documentation requests and serve as the primary liaison between providers, insurance companies, regulatory agencies, and internal departments.• Communicate effectively and professionally with all stakeholders to resolve credentialing-related issues or discrepancies in a timely manner.• Participate in quality assurance activities to ensure the accuracy and integrity of the credentialing process. Identify areas for improvement and implement necessary changes to enhance efficiency.• Attending weekly update meetings.• Any and all duties as assigned. Qualifications To perform this job successfully, the ability to perform each essential duty satisfactorily is necessary and the qualifications listed below are representative of the knowledge, skill, and/or ability required: • High school diploma, general education degree (GED).• Previous experience in medical credentialing or related field.• Knowledge of credentialing processes, regulations, and standards.• Familiarity with medical terminology and the healthcare industry.• Attention to detail and organizational skills.• Excellent communication and interpersonal skills.• Proficient in using credentialing software and databases.• Ability to work independently and handle multiple tasks simultaneously.• Adherence to ethical standards and confidentiality guidelines. QUALIFICATIONS PREFERRED• Associate or Bachelor's degree. Why work for us? At Symbria our employees act like owners – because we are owners! As one of the few 100% employee-owned healthcare providers, our focus remains on delivering best-in-class services within our Pharmacy, Rehabilitation and Well-Being operations, which allows our clients to improve the lives and well-being of their patients and residents. Our teams utilize insights and analytics to drive better health outcomes for our partnered post-acute and senior living communities while providing them with flexible service options. Symbria’s Core Values drive the way we partner with those clients, their patients and residents and the way our diverse employee-owners work together: Integrity – Honest, Fairness and ethics Compassion – Commitment to serving seniors Stewardship – Maximizing mission and margin Innovation – Striving to enhance our value to your organization Teamwork – Working together unselfishly toward goals As an employee-owner, Symbria’s success becomes your success. In addition, we provide: Competitive pay, aligned with market guidelines Full Benefits Package, including very generous paid time off plans Professional liability coverage 100% employer-funded ESOP retirement plan 401(k) and Roth(k) plans Continuing education Credit union membership All applicants will be afforded equal opportunity without discrimination because of race, color, religion, sex, sexual orientation, marital status, order of protection status, national origin or ancestry, citizenship status, age, physical or mental disability unrelated to ability, military status or an unfavorable discharge from military service.