Credentialing Coordinator - Military veterans preferred

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

SUMMARY: The Credentialing Coordinator is responsible for providing administrative and technical support to credentialing services and functions.

DUTIES AND RESPONSIBILITIES:

• Populates, updates, and maintains credentialing software and filing systems
• Processes request, investigation, verification, tracking and follow up of primary responses from various sources.
• Identifies, investigates, reports, tracks, and forwards to credentialing team for follow-up on any potentially adverse information received from credentialing sources.
• Obtains and maintains appropriate knowledge of company policy and procedures, accreditation standards, state and federal regulations, guidelines, procedures and laws required in credentialing process.
• Assists with Requests for Proposals or any requested reports as necessary and in collaboration with supervisor or other Credentialing Services staff.
• Maintains practitioner files annually or on an as needed basis.
• Collects site visit information from Provider Relations on appropriate practitioner files & maintains credentialing software and filing systems
• Works with Credentialing team to identify and coordinate any risk management, substance abuse and/or malpractice issues. Reviews files for any "red flag" concerns.
• Maintains strict confidentiality of all records, data and occurrences as condition of initial and/or continued employment.
• Responsible for complying with Paradigm IT security requirement and policies.
• Responsible for safeguarding Paradigm or Paradigm related IT passwords.
• Responsible for notifying Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management.

QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Exceptional communication and telephone skills required, as well as a great deal of patience and understanding.
• Experience working with physicians and/or senior executives preferred.
• Possess a high level of self-confidence and persistence; maintain an assertive approach in dealing with providers.
• Must possess excellent organizational skills and the ability to multi-task effectively.
• Demonstrate the ability to prioritize heavy workload and work independently with minimal supervision.
• Proficient computer and internet skills; familiarity with Microsoft Office software required.
• Knowledge of medical terminology preferred.
• Will develop in-depth knowledge of department and company internal workflows including, but not limited to individual state’s procedures and negotiating protocols.
• Bilingual a plus.

Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.