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Credentialing Coordinator - Health Alliance Plan

Company: Henry Schein
Location: Troy
Posted on: May 23, 2023

Job Description:

General Summary:

Under minimal supervision, responsible for initial and re-credentialing functions including completion of the application and verification process, Credentialing Committee preparation and follow-up, coordination with contracting and interaction with practitioners, office staff and network representatives.

Principal Duties and Responsibilities:

  • Responsible for all aspects of the CAQH credentialing application and verification process for initial and re-credentialing requests. Assess completeness of information and practitioner qualifications relative to regulatory standards and guidelines including NCQA, CMS, MDCH and HAP's established standards; maintain credentialing files according to regulatory standards and guidelines including NCQA, CMS MDCH, and HAP's standards.
  • Assure all practitioner data is accurate and up to date in the CACTUS/Sympir credentialing software application, including generating and monitoring reports.
  • Responsible for on-going communication with internal and external customers. Respond to all correspondence within 48 hours. Consult with management quickly if unable to resolve within expected time frame.
  • Coordinate, implement, analyze, and close annual delegated audits, as assigned. As issues are identified, resolution must be documented and completed in a timely manner and in accordance with regulatory standards.
  • Organize and maintain practitioner files following confidentiality guidelines.
  • Extract and present key information including CAQH credentialing application and credentials, and identification of potential practitioner issues to facilitate the Credentials Committee decision- making process.
  • Maintain tickler systems for follow-up of unanswered correspondence to maintain department standards for application processing time.
  • Participate in all data integrity projects, as identified.
  • Provide cross-coverage for other Coordinators, as needed.
  • Perform other related duties as assigned.

    Education Required:

    • Associate degree in business, health care or related field or four (4) years of related experience in healthcare industry, managed care experience in lieu of degree.


      • Bachelor's degree in business, health care or related field preferred.

        Experience Required:

        • Minimum of two (2) years' experience in managed care.
        • Minimum of two (2) years of recent experience in physician credentialing or related experience.


          • Minimum of two (2) years' CACTUS physician credentialing software experience.
          • Knowledge of Council for Affordable Quality Healthcare (CAQH) Practitioner Application.

            Certifications/Licensures Required:

            • Certification as CPCS (Certified Provider Credentialing Specialist) or CMSC (Certified Medical Staff Coordinator) preferred.

              Skills and Abilities:

              • Ability to work under minimal supervision.
              • Ability to perform detail work efficiently and with a high degree of accuracy.
              • Excellent problem-solving skills.
              • Highly organized.
              • Ability to initiate and coordinate multiple projects simultaneously.
              • Excellent verbal communication skills.
              • Ability to interpret information and make judgements quickly.
              • Ability to interact professionally with practitioners and other external customers.
              • Strong quantitative and analytical skills.
              • Computer proficient in Microsoft Office including Word and Excel
              • Knowledge of the principles and practices of credentialing is highly desirable.

                Physical Demands/Working Conditions:

                • Typical office environment.
                • Sedentary - Exerts up to 10 lbs. of force occasionally to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for periods of time.
                • Talking - Expressing or exchanging ideas by means of the spoken word.
                • Hearing - Perceiving the nature of sounds.

                  The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities and duties of personnel so classified.

                  Additional Details

                  This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.


                  Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a

                  $6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

                  including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

                  other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

                  now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

                  of the nation's oldest physician groups. An additional 2,200 physicians are also affiliated with the

                  health system through the Henry Ford Physician Network. Henry Ford is also one of the region's

                  major academic medical centers, receiving between $90-$100 million in annual research funding and

                  remaining Michigan's fourth largest NIH-funded institution. Also an active participant in medical

                  education and training, the health system has trained nearly 40% of physicians currently practicing

                  in the state and also provides education and training for other health professionals including nurses,

                  pharmacists, radiology and respiratory technicians. visit


                  Whether it's offering a new medical option, helping you make healthier lifestyle choices or

                  making the employee enrollment selection experience easier, it's all about choice.Henry

                  Ford Health has a new approach for its employee benefits program - My Choice

                  Rewards.My Choice Rewards is a program as diverse as the people it serves.There are

                  dozens of options for all of our employees including compensation, benefits, work/life balance

                  and learning - options that enhance your career and add value to your personal life.As an

                  employee you are provided access to Retirement Programs, an Employee Assistance Program

                  (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness,and a whole host of other benefits and services.Employee's classified as contingent status are noteligible for benefits.

                  Equal Employment Opportunity/Affirmative Action Employer

                  Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is

                  committed to the hiring, advancement and fair treatment of all individuals without regard to

                  race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

                  weight, marital status, family status, gender identity, sexual orientation, and genetic information,

                  or any other protected status in accordance with applicable federal and state laws.

Keywords: Henry Schein, Troy , Credentialing Coordinator - Health Alliance Plan, Healthcare , Troy, Michigan

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