GENERAL DESCRIPTION OF POSITION
The Credentialing Coordinator is responsible for managing the day-to-day operations of the Credentialing team. This includes oversight of the credentialing and recredentialing of employees who provide patient care at North Country HealthCare, Inc. Credentialing functions include, but are not limited to, processing credentialing applications, performing primary source verifications and updating and maintaining credentialing database in accordance with internal policies and procedures,insurance plans contracts, Human Resources and Services Administration (HRSA), National Committee for Quality Assurance (NCQA), URAC,and Center for Medicare Services (CMS) guidelines as well as applicable state and federal requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Supervises the day-to-day activities of the Credentialing team by coordinating daily workload and distribution to the Credentialing Specialists.
Support and participate in an effective performance management processes that promote continuous Improvement.
Participate in the preparation and update of Policy and Procedure documentation.
Conduct 1:1 meetings with Credentialing Specialists.
Conducts annual reviews for Credentialing Specialists.
Responsible for monitoring time and attendance of Credentialing team.
Timely and accurate reporting to management, in regards to department performance goals and objectives.
Identify issues and work with the Management team to develop/implement resolutions.
Coordinate and supervise special credentialing projects as needed.
Assist team members with the initial credentialing and recredentialing functions for employed and contracted providers, which may include collaborating providers and locum tenens.
Provide introductory and ongoing training and education to Credentialing staff to ensure that Policies and Procedures are followed.
Meet with the Business Office Manager regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes.
Assist with staff communication, providing updates, resolving issues, setting goals, and maintaining standards.
Handle difficult and/or escalated internal and external client follow up issues.
Take a lead role with special studies and/or projects related to provider on-boarding, credentialing and insurance plans credentialing and provider enrollment.
Assist Business Office Manager with development and implementation of project action plans, participate in special projects as needed to evaluate insurance plans operational requirements and reimbursement.
Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential, enroll, bill and obtain reimbursement for services rendered. Discovery of such information are conveyed to the Business Office Manager so that the optimal course of action is taken to remedy the finding.
Review provider applications for completion and accuracy and ensure appropriate follow-up; monitor and report on the credentialing progress of each provider. Ensure all providers who require collaboration agreements are appropriately assigned to a collaborating physician and the agreement is executed by both parties; monitor and report progress of each provider.
Prepare provider credentialing and recredentialing files for review by the Medical Executive Committee, attend meetings, draft and maintain meeting minutes reflecting committee peer review, approvals and denials.
Coordinate with insurance plans to ensure provider credentialing and enrollment lag time is at minimum levels; serve as primary liaison with insurance plans for any provider data issues.
Create and maintain databases to assimilate and track insurance plans information and provider credentialing and enrollment requirements; prepare standard and ad hoc reports as needed; analyze and maintain all reports related to provider credentialing and enrollment with insurance plans.
Research provider issues such as payment denials due to insurance plans participation status, provider specialty and service locations and notifies appropriate parties.
Maintain timely and accurate data entry and periodically revise provider data in the credentialing database; maintain provider paper and electronic data files for providers.
Enroll providers with all appropriate insurance plans; monitor and report on progress of each provider. Ensure timely and accurate credentialing and recredentialing application submissions for each provider as it relates to insurance plans; monitor and report progress of each provider.
Regular and predictable attendance.
Continuous learning in both personal and professional development.
Consistent review, comprehension and reply of company email and related correspondence.
Five of more years of office and clerical experience.
One or more years of supervisory experience with one or more employees.
One or more years of credentialing or related experience.
$38,000.00/YR to $52,000.00/YR
North Country Healthcare