ENROLLMENT AND CREDENTIALING COORDINATOR

Reports to: Revenue Cycle Director

About the Role

The Enrollment and Credentialing Coordinator provides coordination of credentialing and enrollment requirements for all licensed staff, contractors, volunteers, and students with patient contact. Provides support to the revenue cycle department for provider-related administrative needs and project support at a high level of expertise. Duties require a high level of professionalism in written and verbal communication, effective organization, and accuracy while carrying out diverse assignments in a fast-paced environment.

Responsibilities

• Partner with an outside vendor to coordinate all credentialing activity paperwork including applications, verifications, and paperwork related to obtaining appropriate leadership and Board approvals.
• Administer MA Extern and NP/PA Student Rotation programs.
• Oversee credentialing and related requirements, staying abreast of requirements and maintenance for JCAHO, HRSA, and FTCA.
• Conduct credentialing maintenance to ensure licenses and certificates are kept up to date.
• Maintain hard copy and electronic records of credentialing activity for all credentialing and re-credentialing information.
• Provide updates to insurance brokers for professional liability insurance.
• Work with department director on related policies and procedures to support requirements and standards.
• Obtain forms/paperwork and process provider enrollment for all payers including private insurance plans, Partnership HealthPlan, CAQH, PECOS, etc.
• Provide credentialing support for audits and site visits.
• Perform ongoing monitoring and updating between credentialing/recredentialing cycles.
• Maintain credentialing and enrollment data in Credential Stream and Verity Stream.
• Assist HR with coordinating CPR classes and required employee enrollment/completion.
• Log and file all BLS certifications.
• Partner with Human Resources to track CME.
• Track data required for compliance, enrollment, and credentialing, including current licensing.
• Reach out and partner with providers to obtain information and support them during any enrollment or credentialing activity.
• Administer Student Loan Forgiveness Program and SRCH Forgivable Loan Program.
• Responsible for credentialing/re-credentialing OCS’s (Other Clinical Staff, etc.).
• Other duties as assigned.

Requirements

• Four-year degree in a related field from an accredited college or university, or equivalent experience preferred.
• One year of experience in medical staff credentialing required.
• One year of experience in medical staff enrollment required.
• Three to six years of experience in medical staff credentialing preferred.
• Three to six years of experience in medical staff enrollment preferred.

Skills

• Highly organized, accurate, and detail-oriented.
• Ability to quickly learn new computer programs, including electronic records and database applications.
• Impeccable honesty and integrity.
• Demonstrates knowledge of enrollment, credentialing, and compliance issues within the community clinic environment.
• Demonstrates a willingness to report any incident that is unusual or incompatible with accepted clinic procedures.
• Always maintains confidentiality of patients and employees.
• Advanced proficiency with Microsoft Office applications including Outlook, Word, and Excel; PowerPoint skills preferred.
• Strong organizational skills with the ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.
• Strong written and verbal communication skills.
• Strong interpersonal skills and ability to work with people of diverse backgrounds and educational levels.
• Ability to work independently and as part of a team.
• Good judgment, problem-solving, and decision-making skills.

Pay

Hourly range: $28.04–$30.96 (DOE)

Physical Requirements

• Use standard office equipment and access, input, and retrieve information from a computer.
• Use a computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods.
• Communicate effectively in person or via telephone, including with a diverse population.
• Give and follow verbal and written instructions with attention to detail and accuracy.
• Perform complex mental functions and basic arithmetic; interpret complex laws, regulations, and policies; collect, interpret, and/or analyze complex data.
• See details of objects at close range.
• Coordinate multiple tasks simultaneously.
• Reach forward, up, down, and to the side.
• Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.
• Lift up to five (5) pounds.