Credentialing Coordinator

At Clinical Associates, we make being healthy easier. We connect our patients to a seamless system of integrated medical care, which includes in-house specialists in areas of practice, from cardiology to podiatry. We also offer unique services like our nuclear stress testing facility. Our physicians, specialists and credentialed health care providers are assisted by 175 trained support staff. We do our best to take care of everything for our patients –medical records, scheduling appointments, coordinating with providers and specialists, and each of our offices has laboratory centers for tests and blood work on site.

515 Fairmount Avenue, Towson, MD 21286

Monday - Friday (onsite) 8:00am - 4:00pm or 8:30am - 4:30pm

Onsite in person attendance is required.

Include but are not limited to:

• Perform all duties related to credentialing/re-credentialing and enrollment of payors for initial and current providers.
• Provide credentialing application to all newly hired providers, assist with completion of all applications, and needed documents with timely return for processing.
• Perform all duties related to provider departure including notification to payors and hospitals.
• Verify all credentials and malpractice claims through the state licensing board and other PSV sources.
• On an ongoing basis, remind providers when licenses require renewal.
• Assure applications are processed within a thirty-day processing time frame.
• Coordinate all credentialing-related appointments with the hospital.
• Facilitate the reappointment process for hospital privileges.
• Maintain/update physical credentialing files for each provider.
• Maintain all credentialing databases such as CAQH, NPDB, NPPES, PECOS, e-PREP and other identified databases.
• Provide updated licensing and other pertinent documentation to hospitals as required to maintain privileges.
• Complete check requests for hospital fees/dues.
• Work with payors to ensure accurate information is reflected for Clinical Associates’ providers.
• Act as liaison between administrative staff of Clinical Associates and the payors in resolving credentialing issues for physicians.

• Request malpractice insurance for newly hired providers as appropriate.
• Request claims history from malpractice company as needed.
• Perform all administrative duties as related to renewal of malpractice insurance for the company.
• Process tail coverage for all departing providers following policies of the malpractice insurance company and Clinical Associates.
• Provide copies of malpractice face sheets to appropriate entities as needed.

• Facilitate payor contracts.
• Initiate and renegotiate MCOs and small to medium commercial payor contracts for Clinical Associates.

• Assists in troubleshooting claims being denied payment by the insurers.
• Assist Billing Manager in any assigned duties or projects.
• Address billing tasks related to credentialing issue denials.
• and send billing documents to Next Gen.
• Back up Charge Entry staff.
• Assist Managers and staff with Payor participation questions.
• All other duties as assigned

• Bachelor’s Degree.
• Will consider non-degreed candidates with significant relevant experience of at least 2 years with hands on credentialing of providers.
• CPCS certification preferred.
• Extensive familiarity with insurance carriers’ credentialing requirements.
• Computer literate (Excel, Nitro, Access) with a willingness and ability to learn new applications.
• Knowledge of Credentialing databases and other software programs to include CAQH, NPDB, e-PREP, NPPES and PECOS.
• Knowledge of EMR systems - Nextgen is a plus!
• Experience with checking provider status in various databases, such as NPPES, CDS, DEA, OIG, Medicare, NPDB, etc.
• Excellent oral communication skills with ability to hear and to speak standard English clearly and concisely.
• Excellent written communication skills with ability to read, write and spell standard English clearly and concisely.
• Ability to interact effectively with culturally diverse patient, practitioner, and employee population.
• Ability to convey a positive attitude and project a professional image.
• Ability to remain flexible and manage multiple tasks and priorities.
• Ability to maintain confidentiality.
• Ability to maintain reliable attendance.
• Requires long periods of sitting, intermittent standing, reaching, and bending.

• PTO
• Paid Holidays
• 401K with company match
• Health and Wellness benefit
• Life Insurance
• Long Term Disability
• Health, Dental and Vision Insurance

Clinical Associates is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.