Payor Credentialing Coordinator

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)

• $10,000 Student Loan Repayment ($5,000 part-time)

• $1,000 Professional Development per year ($500 part-time)

• $250 Wellbeing Fund per year($125 for part-time)

• Matching 401(k)

• Excellent medical, dental and vision coverage

• Life insurance

• Annual Employee Salary Increase and Incentive Bonus

• Paid time off and Holiday pay

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

• Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional and financial well-being.

• Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Description

The Payor Credentialing Coordinator reflects the mission, vision, and values of NMHC, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Managed Care Payor Credentialing Coordinator is responsible for initiation, completion and processing of all commercial and governmental payor credentialing for new and existing providers including mid-level providers.

Responsibilities:

• Works with Payors to credential and re-credential providers and resolve participation/credentialing issues in a timely, organized manner. Notifies applicable staff of providers effective dates.

• Maintains all internal electronic database, correspondence and on-line information regarding Payor participation.

• Rosters out providers to the payer plans. Maintains delegated credentialing status with all the payers by following the NMPN Credentialing guidelines, policies and procedures.

• Uses automated credentialing systems (Morrisey) as required.

• Completes all credentialing applications within established time frames.

• Works with various departments and staff (Provider onboarding team, medical staff office and parallel facilities, NMPN, practices, CVO, etc.) to obtain required information.

• Ensures credentialing compliance with delegated credentialing agreements, payor plans, CMS laws, NMPN policies and procedures and NCQA standards.

• Works with Credentials Committee to make informed decisions about the providers accepted into the network

• Initiate and update the re-credentialing process ribbon for re-appointment application(s) launched, re-appointment application(s) in process, PSV complete recred and CVS complete recred.

• Works with payors to resolve all credentialing issues from sites, business office, payors, etc.

• Obtains formal termination requests as well as clarification when necessary. Terminates provider from system and plans. Sends termination email notification to appropriate internal teams.

• Stays informed and current on the provider groups payor plans, plan participation effective date formulas and carve outs.

• Load providers to appropriate plans based on payer, group and specialty.

• Maintains regular scheduled meetings with payers in order to discuss issues, workflow, loads, and/or additional needs. Reports information from meetings back to appropriate departments when necessary.

• Responsible for notifying payors of all provider changes (address, terminations, etc.) and reconciling payor rosters on established time frames.

• Additional responsibilities may include project work.

Qualifications

Required:

• 3+ years of previous physician payor, billing, practice or related experience.

• Proficiency in Microsoft Office software and overall computer systems skills.

• Proficiency in Microsoft Excel software to read and edit reports.

Preferred:

• Bachelor's degree or 6 years of job-related experience.

• Previous experience in Credentialing, Managed Care or Medical Staff Office.

• Understanding of Medicare, Medicaid, HMOs, PPOs and private insurance companies.

• Understanding of the Morrisey system.

• The ability to create and maintain information database.

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.