Credentialing Specialist/Coordinator - Family Health Center : Job Details

Description:The Credentialing Specialist/Coordinator is responsible for maintaining active status for all providers by successfully completing initial and subsequent Re-Appointment and Re-Credentialing packages as required by the Health Center and for our admitting hospital (UMass), our commercial payers, Medicare and Medicaid.Responsibilities:Provider OnBoarding (Privileging/Credentialing)

• Initial Contact/Support to Provider's with Privileging & Credentialing process at acceptance of employment
• Initiate Provider Hospital Credentialing for Physicians, collaborate w/UMass to maintain Physician Hospital Appointments
• Maintain internal provider ID''s roster to ensure all information for Provider's is accurate and logins is available (NPI/PECOS access)
• Complete/Provide support to providers in Applying for and renewing provider licenses; Professional, DEA, Controlled Substance, and any other required supporting documentation to practice medicine.
• Perform all Primary Source Verifications as required by CMS/HRSA/Joint Commission/NCQA for all Health Care Professionals at initial and Re-Appointments of all LIP's.
• Facilitate/Support providers in signing up and/or obtaining compliance trainings, CME's, Life Support Trainings when due
• Re-Credential providers as required for both the Health Center and for UMass
• Board-Provider List
• Board Letters

Credentialing Compliance:

• Maintain accurate provider credentialing profiles in (Cactus) Cred software.
• Track and Report Monthly on all Credentialing Expirables

Provider Health Plan Enrollment (Revenue Cycle):Complete revalidation requests issued by both MassHealth and PECOS for all providers.

• Complete credentialing applications to enroll providers to commercial payers, Medicare, and Medicaid
• Track/Report Provider enrollment progress
• Initiate and Maintain each provider's CAQH database file timely and according to the schedule published by CMS
• Complete re-credentialing applications for commercial payers
• Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
• Create/Maintain accurate provider profiles on online profiles in CAQH, PECOS, NPPES, MassHealth/C3 and CMS databases
• Other duties as assigned

Knowledge, Skills and Abilities:

• Knowledge of provider Credentialing & Provider Enrollment and its direct impact on the practice's revenue cycle
• Excellent computer skills including Excel, Word, and Internet navigation for State, Federal sites and healthplan searches
• Detail oriented with above average organizational skills, and time management
• Plans and prioritizes to meet deadlines
• Excellent customer service skills; communicates clearly, effectively and professionally

Education and Experience:

• High School Diploma, GED, Associates /Bachelors degree
• 2 years credentialing experience preferred
• 2 years experience in a medical practice business office role required