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Coordinator, Credentialing

Company: Evolent Health
Location: Arlington
Posted on: November 22, 2020

Job Description:

It---s Time For A Change---Your Future Evolves HereEvolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.Are we growing? Absolutely---56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of ---Becker---s 150 Great Places to Work in Healthcare--- in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D) efforts: Evolent achieved a 95% score on its first-ever submission to theHuman Rights Campaign---s Corporate Equality Index; was named one of theBest Companies for Women to Advance List 2020 by Parity.org; and we publish aDiversity and Inclusion Annual Reportto share our progress on how we---re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you---re looking for a place where your work can be personally and professionally rewarding, don---t just join a company with a mission. Join a mission with a company behind it.What You---ll Be Doing:sition Summary:This position is responsible for determining provider types who require credentialing, initiating Primary Source Verification Process (PSV) to begin the credentialing process for the provider. This entry level position reports to the Manager, Provider Credentialing. Responsible for full credentialing and recredentialing life cycle for Health Plan network providers Ensures credentialing and recredentialing files are worked timely and within established Service Level Agreements and Health Plan contractual requirements Maintain and a working knowledge of current version NCQA related to credentialing and recredentialing requirements Comply with all NCQA credentialing and recredentialing standards and guidelines Working knowledge of Health Plan---s credentialing and recredentialing policies and procedures Write and maintain current desktop procedures, as requested Review practitioner and facility credentialing and recredentialing to make sure all elements are present, within NCQA, Medicaid and/or Medicare timeframes, prior to CMO/Credentials Committee review Facilitate and record meeting minutes and prepare all at-risk provider profiles for Credentialing Committee Ongoing monitoring of exclusions, sanctions and adverse events, on a monthly basis Represent Credentialing department in meetings and delivering projects, as assigned Create, review and publish reports and audits Assist with generating and/or validating departmental reports Assist with preparing documentation requested for internal and external audits Performs other duties as assigned by the Team Supervisor or Manager Tracks complaints, resolution times, and complaint patternsKey Competencies/Success Factors: Lives the values: Integrity, Community, Collaboration and Stewardship, as defined in the performance appraisal Proficient PC skills in a Microsoft Office based environment Excellent verbal and written communication skills Detail oriented with good organizational skills and ability to enter data with accurately in a timely manner Ability to work collaboratively with associates and other departments Ability to handle multiple projects simultaneously Ability to adapt to fluctuating situations and perform work of a detailed nature, avoiding errorsThe Experience You---ll Need (Required): Bachelor---s degree preferred Minimum of two years--- experience in healthcare field related to credentialing, provider enrollment and/or provider services 3 --- 5 years of accurate data entry and maintenance of databases, specific to credentialing, provider enrollment and/or provider servicesTechnical Requirements:Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Keywords: Evolent Health, Arlington , Coordinator, Credentialing, Other , Arlington, Virginia

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