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 Credentialing Coordinator, MSO Billing Office, Full-Time - Annapolis, Maryland, United States

   
Job information
Posted by: Anne Arundel Medical Center 
Hiring entity type: Health and Medical Svcs. 
Work authorization: Not Specified for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Accounting
 
Travel: Unspecified 
Accept candidates: from anywhere 
Languages: English - Fluent
 
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 12600693 / Latpro-3782352 
Date posted: Mar-31-2021
State, Zip: Maryland, 21402

Description



Position Objective:

The Credentialing Coordinator is responsible for creation of, reviewing and processing credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with payers. This individual must maintain accurate records for each provider at all times. This individual is an essential part of the new provider initial credentialing process as well as existing provider re-credentialing process.

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

  1. Maintains integrity of Credentialing database, by entering new providers and updating provider and practice information on an as needed basis. Completes monthly provider grid reports in a timely manner. Maintains integrity of provider files, in alphabetical and prescribed formats.
  2. Prepare the CAQH application for newly affiliated and existing healthcare providers Maintains credentialing databases and ensures up-to-date tracking of file process.
  3. Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership.
  4. In-depth working knowledge of the various payer applications associated and the workflow process.
  5. Ensure all workflow items are completed within the set turn-around-time, meeting quality expectations.
  6. Takes an active role in improvement process, anticipates problems, makes suggestions and independently resolves minor obstacles.
  7. Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.
  8.  Generates letters to practice leadership in advance of documents' expiration dates to request copies of current documents. (E.g. license, CDS, DEA, malpractice insurance certificates)
  9. Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.
  10.  Ability to work within a deadline-intense environment.

Educational/Experience Requirements:

  • 3 years of experience in a centralized credentialing office and direct provider enrollment experience, such as credentialing or file maintenance, preferred with experience in Word and Excel
  • Knowledge of health plan and governmental payer credentialing, enrollment and requirements acquired through completion of a CPCS certification course, or sufficient job-related experience with intent to pursue certification.
  • Knowledge of Microsoft Word and other PC applications including preferred experience in a medical staff electronic database system, i.e. MD Staff.
  • Knowledge of PECOS and State Medicaid Enrollment applications
  • Knowledge of standards interpretation as related to NCQA
  • Required License/Certifications:

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.



Requirements

See job description

 

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