JOB POSITION: Credentialing Coordinator
LOCATION: Mount Prospect
REPORTS TO: Revenue Cycle Supervisor
JOB DESCRIPTION: Responsible to assist us with administrative tasks pertaining to our practitioners' credentialing, by successfully completing initial and subsequent credentialing packages as required by Medicare and Medicaid, commercial payers, hospitals, regulatory agencies. The Credentialing Coordinator will organize, maintain and verify all aspects of the process, and maintain current files on practitioners. You will track the expiration of certifications to maintain up to date files and assist health plan providers and customers with phone inquiries. MUST have healthcare credentialing experience!
To be successful in this role you should ensure accuracy of all information. Will be reliable, energetic and have excellent people skills.
- Processing initial credentialing and re-credentialing applications.
- Screening practitioners' applications and supporting documentation to ascertain their eligibility.
- Collecting information from National Practitioner Data Bank (NPDB), applicant and their malpractice insurer, and other relevant sources.
- Identifying discrepancies in information and conducting follow-ups.
- Assisting customers with credentialing inquiries.
- Responding to health plan provider inquiries.
- Capturing primary source documentation in computer databases.
- Work closely with the Billing and Authorizations Departments to identify and resolve any denials or authorization issues related to provider credentialing.
- Ensuring data is backed up.
- Ensuring compliance with applicable laws, regulations, procedures and policies.
- Any other duties as assigned.
- 2+ years credentialing experience with hospital medical staff.
- 2 years’ experience in a medical practice business office role a plus
- Knowledge of medical credentialing and privileging procedures and standards.
- Excellent verbal and written communication skills.
- Proficient with Microsoft Office Word and Excel.
- Proficient touch-typing skills.
- Ability to focus for extended periods.
- Ability to manage multiple priorities and projects
- Excellent time management skills
- Ability to lead by example
- Self directed and willing to take initiative
- Open minded to change
- Decisive, not afraid to make a decision
- Willing to roll up sleeves and pitch in with staff and doctors to solve problems
- Team oriented with a collaborative approach to problem solving
- Quantitative focus, creates a fact based, “no blame” culture
- Patient focused
- Proven ability to prioritize and organize
- Committed to continuous performance improvement
- Function effectively in a fast-paced work environment
High School Diploma/GED required. Bachelor’s Degree preferred
Minimal Travel between multiple clinic locations and Mount Prospect location as needed - valid driver’s license required
- Physical demands to successfully perform the essential functions of this job including but are not limited to walking, sitting, stooping, kneeling, standing, and crouching
- The employee must be able to regularly lift up to 10 pounds
- No specific vision requirements
- No specific noise requirements
AMERICAN WITH DISABILITIES ACT (ADA) SPECIFICATIONS
Qualified individuals with disabilities may make a request for reasonable accommodation to the Director of Human Resources. Upon receipt of an accommodation request, the Director of Human Resources will meet with the requesting individual to discuss and identify the precise limitations resulting from the disability and the potential accommodation that might help overcome those limitations. The Director of Human Resources in conjunction with a medical review (and, if necessary, other appropriate management representatives) will determine the feasibility of the requested accommodation and the impact on the business operation. The Director of Human Resources will inform the qualified individual of the decision of the accommodation request or how to make the accommodation.