Credentialing Systems Coordinator
Description
- Single or Family Health Insurance with discounted premium rates for wellness program participation.
- 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
- Flexible Paid Time Off Program (24 days off/year)
- Medical and Dependent Care Flex Spending Accounts
- Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.
- Act as the Subject Matter Expert for credentialing software by implementing, optimizing, and maintaining this software to ensure streamlined credentialing and recredentialing processes. Proactively identify and resolve software-related issues to ensure seamless workflows and create efficiencies as needed. Complete enrollment applications and manage progress in all insurance networks and managed care organizations in a timely, efficient, and professional manner, ensuring data integrity and accuracy within the system. Support the integration of credentialing software with other systems and train staff on best practices for utilization.
- Complete credentialing and recredentialing paperwork for physician hospital staff appointments for all hospitals and assist with nursing home credentialing paperwork. Utilize software to auto-fill repetitive fields, track status, and maintain centralized documentation for easy access and compliance.
- Work with various agencies and staff to ensure appropriate documentation is received and completed to avoid delays in physician credentialing and recredentialing. Regularly audit and update software data to maintain compliance and prevent errors. Work in conjunction with the Insurance Department to resolve complex billing issues related to provider numbers. Communicate with insurance carriers on a regular basis to maintain proper credentialing for uninterrupted claim reimbursement.
- Establish and maintain physician files with current and accurate credentials, including updating curriculum vitae and coordinating this information for physician directories. Ensure all records are consistently reflected in the credentialing system and kept up to date. Assist physicians with licensing and ensure CME requirements are met for licensing board audit purposes.
- Maintain and optimize the credentialing database, ensuring all physician credentials, personal information, provider numbers, and expiration dates are accurately recorded and monitored. Develop and oversee automated alerts for renewals and compliance tracking, ensuring proactive management of credentialing requirements.
- Provide backup coverage for the Administrative Assistants within the department.
- Complete all other assigned projects and duties.
Physical Aspects:
Reaching - Extending hand(s) and arm(s) in any direction.
Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.
Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.
Grasping - Applying pressure to an object with the fingers and palm.
Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.
Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.
Vision - 20 / 40 or better in the best eye with or without correction.
Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.
Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status. Please view Equal Employment Opportunity Posters provided by OFCCP here.