Managed Care Credentialing Specialist - Northampton, Ma-Hybrid

About Us

With energy and purpose, Cooley Dickinson Health Care, an affiliate of Mass General Brigham, is advancing health care in western Massachusetts. With a broad network of providers and facilities serving the Pioneer Valley, our services span a spectrum of medical and surgical needs, diagnostic care, rehabilitation, social work, behavioral health, and other critical needs of the community.

The Cooley Dickinson culture is built on living the values of our organization. Every employee is valued, no matter what professional function. Come work where you can make a difference every day, with opportunities for growth and development, in a great place to call home!

Department Information & Location

Cooley Dickinson Physician Hospital Organization (CDPHO) is crafted to offer its participating physicians and Cooley Dickinson Hospital improved efficiency in managed care contracting, CDPHO is the preferred managed care contracting entity within Hampshire County for all major health plans. The CDPHO is structured to provide a forum for participating providers to collaborate in the delivery of high quality, cost-effective health care to the community in an organized fashion.

Our physical site is located on the 3rd floor at 30 Locust Street, Northampton, MA 01060.

Schedule

This is an excellent opportunity to work in a hybrid capacity. This position is 40 hours a week and will be on-site 3 days per week for the first 90 days and then 1 day per week on-site once training is successfully completed. Typical hours are Monday through Friday 8:30am-5:00pm.

General Summary

Our Credentialing Specialist is responsible for performing a variety of duties including provider enrollment to support the membership operations of CPHO and to coordinate and submit provider applications for credentialing and participation with contracted health plans. This specialist will also support the Provider Relations Manager in research to bring resolution to provider managed care issues regarding health plan policies and procedures impacting provider enrollment and payment.

Primary Responsibilities to include:

• Maintains PHO membership documents, handles PHO physician enrollment and dis-enrollment as well as maintain applicable databases.

• Prepares and submits physician applications for participating provider privileges in an accurate and timely manner. Provides follow up on applications, facilitates approval process, and communicates provider ID numbers and effective dates to practices and providers.

• Prepares and submits hospital initial applications and re-credentialing for participating facility status in a timely and accurate manner to contracted managed care plans.

• Manages the scanning and/or cataloging of pertinent and current credentialing and enrollment documents for PHO physician members and group practices

• Tracks required hospital privilege status and obtain all required provider contract signatures for initial health plan credentialing and participation.

• Communication/notification of practice changes (address, tax ID, group, retirement, terminations etc.) to all health plans in which provider participates through the PHO.

• Assists the medical staff office with provider onboarding and help resolve ongoing implementation issues.

• Act as advocate for CDPHO providers to resolve enrollment issues that arise and research health plan policies and procedures impacting provider participation and payment.

Qualifications

• High school diploma or equivalent required. Associate Degree in business, accounting, finance or related field; or completion of a healthcare administrative program preferred.

• At least three (3) years of administrative, medical practice management or medical staff coordinator experience in a health care services organization and understanding of health insurance company operations required.

• Showed strength in computer skills required, must have Microsoft Excel experience.