The position is responsible for supporting the Senior Manager of Medical Staff Support Services through an active leadership role amongst the Provider Enrollment coordinators to meet the mission and needs of the Health System.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Prepares and submits recommendations regarding appointments and reappointments to the Physician Enterprise committees, based on verifications and assessments.
- Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contracts.
- Takes an active role in improvement process, anticipates problems, makes suggestions, and independently resolves minor obstacles.
- Maintains integrity of Credentialing database, by entering new providers and updating provider and practice information on an as needed basis.
- Maintains integrity of Delegated Credentialing Rosters by entering new providers and updating provider and practice information on an as needed basis. Maintains integrity of provider files, in alphabetical and prescribed formats.
- Effectively communicates in verbal and written formats, with healthcare providers, payors, coworkers, CBO and provider office staff.
- Generates letters to providers/Practice Managers in advance of documents expiration dates to request copies of current documents. (e.g. license, CDS, DEA, malpractice insurance certificates)
- Meets regularly with the Reimbursement Administrator to discuss operational issues. Meets at regular intervals with Credentialing Coordinators to implement office and personal improvement initiatives.
- Allocates; trains; and enforces internal procedures, controls, and problem resolution amongst the Prover Enrollment Credentialing coordinators.
- Reviews staff timesheets for payroll.
Knowledge, Skills & Abilities:
- Proven ability to use data/business analytics to drive change.
- Demonstrated ability to proactively engage in departmental change, including making recommendations, supporting implementation, and monitoring sustainability.
- Ability to lead with the highest degree of professional and personal integrity
Effective verbal and written communication skills; effective cross-department collaboration skills.
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.