Enrollment And Credentialing Coordinator

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Description

Description

POSITION TITLE: Enrollment and Credentialing Coordinator

REPORTS TO (TITLE): Revenue Cycle Director

Job Summary: The Enrollment and Credentialing Coordinator provides coordination of credentialing and enrollment requirements for all licensed staff, contractors, volunteers, and students with patient contact. Provides support to the revenue cycle department for provider-related administrative needs, and project support at a high level of expertise. Duties require a high level of professionalism in written and verbal communication and effective organization and accuracy while carrying out diverse assignments in a fast-paced environment .

Clarifying Definition:

• Definitions:
  Credentialing (Includes Credentialing/Recredentialing/Privileging/Proctering/Reappointment)
• Enrollment (Includes Medi-Cal, Medicare, private insurance, PECOS, CAQH, Verity Stream, PAVE, 137B Attestation, and other related forms)

• Partnering with an outside vendor to coordinate all credentialing activity paperwork including applications, verifications, and paperwork related to obtaining appropriate leadership and Board approvals.
• Administer MA Extern and NP/PA Student Rotation programs.
• Oversee credentialing and related requirements. Keep abreast of requirements and required maintenance for JCAHO, HRSA and FTCA.
• Conduct credentialing maintenance, to ensure licenses and certificates are kept up to date.
• Maintain hard copy and electronic records of credentialing activity for all credentialing and re-credentialing information.
• Provide updates to insurance brokers for professional liability insurance.
• Work with department director on related policies and procedures to support requirements and standards.
• Obtain forms/paperwork and process for provider enrollment for all payers including private insurance plans, Partnership Health Plan, CAQH and PECOS, etc.
• Provide credentialing support for Audits and Site Visits.
• Perform ongoing monitoring and updating between credentialing/recredentialing cycles.
• Maintains credentialing and enrollment data in Credential Stream, Verity Stream.
• Assist HR with Coordinating CPR classes and required employee enrollment/completion.
• Log and file all BLS certifications.
• Partner with Human Resources to help track CME.
• Track data required for compliance, enrollment, and credentialing. This includes data pertaining to current licensing.
• Reach out and partner with providers to obtain information and support them during any enrollment or credentialling activity.
• Administer Student Loan Forgiveness Program and SRCH Forgivable Loan Program.
• Responsible for credentialing/re-credentialing OCS’s. (Other Clinical Staff, etc.)
• Other duties as assigned.

• Four-year degree in related field from accredited college or university or equivalent experience preferred.

• Three to six years of experience in medical staff credentialing preferred.
• Three to six years of experience in medical staff enrollment preferred.

• Highly organized, accurate, and detail oriented.
• Ability to quickly learn new computer programs, including electronic records and database applications.
• Impeccable honesty and integrity.
• Demonstrates knowledge of enrollment, credentialing, and compliance issues within the community clinic environment.
• Demonstrates a willingness to report any incident that is unusual or incompatible with accepted clinic procedures.
• Always maintains confidentiality of patients and employees.
• Advanced level of proficiency with Microsoft Office applications including Outlook, Word, and Excel. PowerPoint skills preferred.
• Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.
• Strong written and verbal communication skills.
• Strong interpersonal skills. Ability to work with people with a variety of background and educational levels.
• Ability to work independently and as part of a team.
• Good judgment, problem solving and decision-making skills.

• While performing the duties of this job, this position is frequently required to do the following:
• Use standard office…