Credentialing Coordinator

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

Coordinate the process of gathering all credentialing materials. Assist with completion of credentialing new and established health care providers. Maintains and updates provider credentialing database. Ability to build relationships with all levels of personnel within the Zing Health Network organization and external provider networks. 

ESSENTIAL FUNCTIONS:

• Assures credentialing files are complete with the necessary documentation
• Review credentialing applications, apply policy and criteria, perform primary source verification, process files and forward completed files to appropriate area for processing
• Monitors and conducts appropriate follow-up regarding supportive credentialing documentation including current licensure, malpractice status and history, board certification, and related functions according to established time frames.
• Review monthly regulatory and disciplinary action reports issued by State licensure bodies and the Office of Inspector General Medicaid and Medicare Sanctions reports.
• Understand credentialing requirements per Zing Health policies, as well as state and federal requirements.
• Audit provider directories.
• Produce regularly scheduled network and ad hoc reports.
• Attend and provide support for Credentialing Committee meetings.
• Demonstrate consistent ability to multi-task, prioritize and perform independently to execute assigned tasks.
• Special projects as assigned or directed.

QUALIFICATIONS AND REQUIREMENTS:

 JOB REQUIREMENTS:

• High School Diploma
• Two (2)+ years of previous managed care insurance or physician credentialing experience required
• Ability to navigate complex health plan enterprise systems.
• Ability to analyze data for identifying trends, and variance from goals.
• Ability to comprehend JCAHO standards and state and federal laws related to credentialing.
• Ability to work autonomously.
• Efficient and concise communication skills.
• Attention to detail, organized and have excellent time management capabilities
• Microsoft Suite knowledge a must.