Payor Credentialing Coordinator 14932

The Payer Credentialing Coordinator, reporting to the Manager of Physician Division Revenue Cycle, is responsible for the coordination of credentialing and the revalidation process for all NAH employed and contracted physicians, employed and contracted allied health professionals, ancillary services, hospital, hospital clinics, and healthcare facilities.

Responsibilities

Credentialing Management

• Prepares and submits provider enrollment applications and supporting documents with payers to ensure timely enrollment.
• Maintains and checks status of all pending and completed providers' applications with payers.
• Maintains and updates credentialing files which include expirables, database, and rosters.
• Responsible for the creation and maintenance to the CAQH database for the providers credentialed.
• Manages all re-credentialing request from commercial/government payers.
• Reviews new provider files for completeness and prepares and sends follow up requests.
• Responsible for access, control and maintenance of the Medicare Pecos system for NAH.
• Maintains data base/Credentialing software with updated information.
• Communicates payer credentialing status to NAH internal departments.
• Collaborates with the billing department to help identify credentialing problems with providers.
  
  
  

Payer Management

• Communicates non-responsive providers and payers to manager with documentation of request.
• Communicates enrollment status to leadership and other internal departments for scheduling and billing purposes.
• Tracks and follows-up with payers to obtain effective dates with plans.
• Communicates with departments and team members regarding high priority items as they arise.
• Maintains knowledge of managed care environment, operations, and provider contracting.
• Maintains communication with Medical staff office team members.
• Participates in claim denial management due to credentialing or managed care provider effective dates.
• Collaborates with management and staff to improve process within the department and company.
  
  
  

Compliance/Safety

• Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
• Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility.
• If required for position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
• Completes all company mandatory modules and required job specific training in the specified time frame.
  
  
  

Qualifications

Education

High School Diploma or GED- Required

Certification & Licensures

Certified Provider Credentialing Specialist (CPCS)- Preferred

Certified Professional Medical Services Management (CPMSM)- Preferred

Experience

Minimum 2 years of previous healthcare experience- Required

Experience with practitioner and facility credentialing and re-credentialing processes- Required

Experience with completing managed care and governmental credentialing and re-credentialing and re-credentialing enrollment applications for all provider types- Required

Credentialing Software Experience- Preferred

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.