Credentialing Representative II

NextCare Introduction

NextCare strives to be the leader in high access healthcare, offering urgent care, occupational health, virtual health and primary care services to our patients. With offering services in twelve states (Arizona, Colorado, Kansas, Michigan, Missouri, New Mexico, Nebraska, North Carolina, Oklahoma, Texas, Virginia and Wyoming) and over 170 urgent care clinic locations, we offer exceptional, affordable care to patients across the country.

At NextCare, we constantly strive to provide you with the highest degree of caring, growth, integrity, results and teamwork. These essential core values form the foundation of our relationships with patients, customers, investors, partners and one another. Extraordinarily high-performance standards serve as critical guides for making important clinical and business decisions. The expression of these standards is evident in our behavior, our attitude, and our approach to our daily work. The product of our strict adherence to core values is the ability to harness tremendous organizational energy to achieve our goal of upholding the highest standard for quality and service within the high access healthcare. This unique combination of values, performance standards and commitment serves as the key to our success.

What we are looking for

NextCare Urgent Care is looking for a Credentialing Representative II to be a part of our Urgent Care Team.

Location

Join our team in Tempe, AZ.

Responsibilities

• Perform Primary Source verification on all providers.
• Complete and submit credentialing applications for both providers and facilities.
• Maintain files with provider and facility credentials.
• Obtain and supply information to correctly bill services.
• Track information and submit timely.
• Coordinate with Credentialing Representative I to update Primary Source Application every two years.

• Completing any re-credentialing application on the providers.

• Completing and submitting group applications for any new locations or re-credentialing applications.
• Submitting notification letters to plans for new locations or any updates to facilities.
• Assist other members of team as needed.
• Initiate and maintain CAQH files on all Provider’s
• Communicate with multiple departments (Clinics, Billing, Collections) regarding provider status with health plan enrollment
• Audit reports based on information input into database software to ensure accurate information reporting out to various departments
• Attend meetings scheduled with Credentialing Leadership, other NextCare Departments, and health plan representatives
• Document processes and procedures
• Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
• Performs other related duties as assigned or described in Company policy.

How you will make an impact

The Credentialing Representative II processes the necessary paperwork with all required entities to ensure correct credentialing and billing.

Essential Education, Experience and Skills:

Education: Minimum of High School diploma or equivalent

Experience: General computer skills required including experience using Microsoft Office, Adobe PDF, and OneNote (or equivalent). Prior provider enrollment credentialing experience. Written and verbal communication both internal and external.

Valued But Not Required Education, Experience and Skills:

Experience: Working with delegated payer enrollment; knowledge of NCQA standards or equivalent. Understanding of contracting processes. Understanding of revenue cycle in relation to credentialing. Previous experience using credentialing software.

Benefits:

NextCare offers full time employees medical, health savings account, NextCare employee visit program, dental, vision, basic life, voluntary employee/spouse/child life, long term disability, short term disability, employee assistance program, critical illness, accident, legal, identity theft and paid time off benefits. Employees of all statuses are offered 401(k) Plan benefits. Employees in select positions are offered shift differential benefits. Benefits are offered per policy and plan rules.

Equal Opportunity Statement

NextCare Urgent Care is an Equal Opportunity Employer.