Description:
Statement of Purpose: The Credentialing Coordinator supports the Credentialing Department with administrative tasks relating to healthcare practitioner onboarding/offboarding, credentialing and health plan enrollment. In addition, this position supports any demographic changes for physicians and ancillary providers within the clinical group practice. The Credentialing Coordinator will help track provider certifications and licensure expiration dates and ensure that all healthcare providers maintain current credentials and are following regulatory standards. This position interacts often with providers, practice administrators, billing vendors, commercial and governmental health plans, and credentialing vendors.
CAN Values:
Recognize and affirm the unique and intrinsic worth of everyone. Treat all those we serve with compassion and kindness. Act with absolute honesty, integrity, and fairness in the way I conduct my business and the way I live my life. Trust my colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty, respect, and dignity. Essential Functions:
Promotes and practices CAN Community Health Inc's mission and values and follows its policies and procedures. Ensures confidentiality is maintained by entire team regarding patient/client information in accordance with HIPAA, professional and departmental standards. Primary Tasks:
Coordinate with the Credentialing & Health Plan Enrollment Team Lead & Credentialing and Health Plan Enrollment Specialists to ensure that physicians and ancillary providers are properly licensed and credentialed. Provide consistent and timely follow-up with the credentialing process for healthcare providers, including initial credentialing, re-credentialing, and health plan enrollment. Assist with maintaining an up-to-date provider database to ensure that all healthcare providers are licensed, insured, and properly credentialed according to regulatory guidelines. Assist to ensure all credentialing documentation is accurate, complete, and compliant with regulatory standards and health plan requirements. Support the review process of health plan provider rosters and directory reviews/attestations. Participate with provider profile audits with multiple systems. Communicate with healthcare providers, health plans, and regulatory agencies to resolve credentialing issues and ensure timely processing. Coordinate with internal departments to gather necessary information and documentation for credentialing purposes. Compile and maintain accurate records of credentialing and enrollment activities, including tracking deadlines and expiration dates. Participate in quality improvement initiatives to enhance the efficiency and effectiveness of credentialing and enrollment processes. Assist clinical providers with CAQH applications on behalf of CAN employed providers. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Ensure adherence to healthcare regulations, standards, and payer requirements during the credentialing and enrollment process. Maintain up-to-date knowledge of healthcare regulations, accreditation standards, and health plan policies related to credentialing. Adhere to HIPAA regulations and maintain patient confidentiality. Secondary Tasks:
Communicates effectively and collaborates with other departments to implement best practices while accurately complying with healthcare regulations and guidelines. Assists in the set up and maintenance of provider information in online credentialing databases and systems. Assists in maintaining corporate provider contract files. Practice Integrity and Mission and Value statement. Perform other duties as assigned by Revenue Cycle Leadership. Reports to: Sr. Revenue Cycle Manager
Requirements:
Education/Professional:
1. Bachelor's degree in healthcare, Business, Finance, or 3 years equivalent healthcare experience 2. Three -Five years minimum of credentialing coordination experience required. Knowledge, Skills and Abilities Required:
1. Ability to work with minimal supervision. 2. Experience working with medical payers including Medicare, Medicaid, Commercial and third-party administrators. 3. Strong attention to detail and accuracy in data entry and record-keeping. 4. Excellent written and verbal communication and interpersonal skills. 5. Excellent computer skills and proficient in Microsoft Office (EXCEL, VISIO, Word, PowerPoint) and using Internet resources. 6. Excellent people skills, open to direction and commitment to get the job done. 7. Promotes teamwork, productivity, and delivery of high-quality care. 8. High comfort working in a diverse environment with changing priorities. Physical Requirements:
Requires frequent bending, stooping, and standing. Requires visual and auditory acuity, frequent sitting and walking for extended periods of time. CAN is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law
