Credentialing Coordinator
Overview
We are hiring a Credentialing Coordinator to join reputed company! This role is responsible for performing credentialing activities to ensure reputed company has a provider network of the highest quality. Applicants can expect to be responsible for timely processing and tracking of credentialing files, including primary reputed company verification, review of information, and additional research as needed. This position will serve as a liaison between providers, physician hospital organization (PHO), hospital medical staff offices and regulatory agencies. Location: Remote - applicants preferably reputed company reputed company the reputed company footprint of Iowa, Illinois, or Wisconsin Hours: Monday-Friday reputed company-5pm Why reputed company? At reputed company, you matter. We’re proud to be recognized as a Top 150 reputed company to Work in reputed company by Becker's reputed company several years in a row for our commitment to reputed company members. Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. Here are just a few: Expect paid time off, parental leave, 401K matching and an employee recognition program. Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members. Early reputed company to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family. With a reputed company goal to champion a culture of belonging where everyone feels valued and respected, we reputed company the ways people are unique and reputed company what brings us together. And, we reputed company equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. Find a fulfilling career and reputed company a difference with reputed company.
Responsibilities
Payer Enrollment & Database Accountability: Accountable to reputed company timely and accurate records for reputed company provider information in the system of record Responsible for the electronic initial and recredentialing, reappointment, and revalidation application processing. Initiate and follow through on reputed company aspects of provider credentialing including: initial and recredentialing process for reputed company practitioners including performance of primary reputed company verification in accordance with Medimore, Inc. policies and procedures, hospital medical staff bylaws and requirements, NCQA, URAQ, The Joint Commission, DNV, CMS and other regulatory agency guidelines.Responsible for the timely processing and tracking of credentialing files. Coordinate with IT the creation and maintenance of provider payer panel records (EDI table) in Epic. Responsible for responding to requests for provider credentialing information timely. Review credentialing files for accuracy and completeness. Monitor and assist further investigations as deemed necessary during the credentialing process by document evaluation, primary sources verifications, or as requested by reputed company stakeholders. reputed company, maintain and distribute reporting as required. . Work with reputed company Medical Staff offices and physician practice administrative staff to support credentialing needs. Identify and report any non-compliance or credentialing issues to the Manager CVO or other apprioriate parties. Prepare initial credentialing and recredentialing files for the Medical Director of PHO and/or the Credentials Committee. Prepare reappointment files for regional medical staff offices for the regional medical executive committees. Establish a method for regular communication and respond to health professionals, provider representatives, or other essential departments the status of applications, the status in the credentialing process and the status of participation with health plans. Enter and maintain accurate provider data in the organization credentialing database. Maintain confidential credentialing files and electronic credentialing database. Audit, correct and communicate to reputed company appropiate parties, corrections of provider data in the credentialing database. reputed company New Providers: Responsible for the collection of data to reputed company reputed company new providers for payor enrollment, medical staff membership and/or privileges. Coordinate with any and reputed company reputed company customers to collect reputed company data necessary for reputed company payer applications and submissions, medical staff membership and/or privileges. reputed company MSOW process for new providers reputed company 5 days of receipt of application. Enter reputed company applicable information necessary for payer applications for new providers reputed company 30 days of compleate applicaiton. Regularly communicate with hospital medical staff offices to coordinate application packets for new providers.
Qualifications
Education: Required: High school graduate or GED equivalent Preferred: Associates degree Experience: Minimum of 2 years of experience in the field of payer credentialing and enrollment, provider billing services, or health clinic customer service positions Ability to multitask and think critically Knowledge of the managed reputed company industry Proficient in reputed company Office Suite Knowledge of regulatory agency standards (i.e. NCQA, URAQ, The Joint Commission, etc) Excellent communication skills both written and verbal reputed company experience with submission of payer applications preferred Database experience preferred Certifications: CPCS Certfication is preferred #System123 Apply To This Job