Credentialing Administrator Salary in Hillsborough, North Carolina

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Average Salary for Credentialing Administrator in Hillsborough, North Carolina

The average salary of a(n) Credentialing Administrator in Hillsborough, North Carolina is $73,787.

The average hourly rate of a(n) Credentialing Administrator in Hillsborough, North Carolina is $35.47.

The average bonus of a(n) Credentialing Administrator in Hillsborough, North Carolina is $2,826.00.

Job Description:

Credentials and recredentials participating providers and facilities in the health plan. Analyzes and resolves complex provider issues relative to credentialing, enrollment, billing, and payers. Coordinates and performs enrollment of assigned providers and physicians in appropriate health plans to ensure satisfaction of the health plan requirement for acceptance. Typically requires a bachelor's degree in a health care field or be a Registered Health Information Administrator (RHIA). Typically requires experience sufficient to provide a working knowledge of NCQA and JCAHO. Reviews and processes provider applications and determines eligibility by applying NCQA, JCAHO, and URAC standards as related to the network. Performs primary source verification for initial and recredentialing of assigned providers utilizing NCQA and other federal and state regulatory requirements. Communicates with providers regarding credentialing status and information. Creates and maintains participating provider or practitioner credentialing files. Reviews and analyzes provider file changes. Creates practitioner profiles for recredentialed practitioners. Prepares and sends application packets to participating providers and facility applicants, requesting the return of basic credentialing information. Reviews applications for completeness and assists the applicant in completing the application. Prepares routine credentialing reports. Reviews and monitors provider complaint and grievance files. Less

Credentials and recredentials participating providers and facilities in the health plan. Analyzes and resolves complex provider issues relative to credentialing, enrollment, billing, and payers. Coordinates and performs enrollment of assigned providers and physicians in appropriate health plans to ensure satisfaction... More

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