Credentialing Administrator

Concentra•Addison, TX

11d•Onsite

About The Position

The Credentialing Administrator provides day-to-day support for the Contracting and Credentialing teams. This role involves launching team workflows in the IntelliCred database, managing and tracking DOT and APC/ATC certifications and compliancy, handling facility credentialing for Group Health payers, tracking group health payer agreements/contracts for executive review, and allocating and submitting expenses for internal credentialing verification charges. The position requires maintaining and tracking DOT certifications for physicians, nurse practitioners, and physician assistants, including researching and validating information via the National Registry of Certified Medical Examiners (NRCME). It also involves maintaining and tracking APC/ATC agreements for compliancy and facilitating, maintaining, and tracking facility credentialing applications for various payer types. The role acts as a liaison for securing facility licenses, conducting internal audits, and launching workflows in the IntelliCred system for various teams. Additionally, the Credentialing Administrator participates in acquisition activities, maintains departmental administrative tasks, creates and maintains internal Facility Listings, prepares reports, tracks contracts for executive review, and reconciles internal credentialing verification charges.

Requirements

High School Diploma or GED
A college degree in related field or equivalent work experience.
Customarily has at least 2 years of administrative skills experience
Moderate to advanced Excel skills
Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility
Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
Ability to accurately type
Detail oriented and highly organized
Microsoft Office Suite
Excellent verbal and written communication skills
Ability to utilize all proprietary Concentra software programs
Ability to work independently within company guidelines and policies
Ability to effectively present information and respond to questions from managers, clients, and customers
Ability to speak effectively in one-on-one situations
Ability to read and comprehend standardized instructions, short correspondence, and memos
Ability to effectively present information in one-on-one situations to other employees, providers, and clients
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
Ability to apply commonsense understanding to carry-out instructions furnished in written, oral, or diagram form
Basic understanding of office equipment (copier, scanner, fax, phone)

Responsibilities

Serve as support for maintaining and tracking DOT certifications for all physicians, nurse practitioners, and physician assistants. Research/validate DOT certification and practice profiles via the National Registry of Certified Medical Examiners (NRCME) website. Notification of DOT certification and practice profile status is communicated to the field EAs and tracked for Concentra compliancy through the IntelliCred database
Serve as support for maintaining and tracking all APC/ATC agreements for compliancy. Submits written request to field EAs for APC/ATC agreements for all new hire, annual/biennial renewals and supervising physician changes of Nurse Practitioners, Physician Assistants, and Athletic Trainers. Completion of APC agreement requests are tracked and monitored for compliancy through the IntelliCred database
Facilitate, maintain and track facility credentialing applications for Urgent Care, Physical Therapy, Primary Care and Work Comp payers. Includes completion of simple to complex credentialing applications with supporting documents such as local, state, and federal licensures, CLIA certificates, center assessment and services offered questionnaires. Credentialing activities are maintained and tracked in the IntelliCred database through various workflows
Act as the primary liaison to secure needed facility licensures by working with internal licensing department, clinical and operational leaders.
Conduct internal audits such as facility rosters and various IntelliCred database validations to ensure data integrity
Launching workflows in the IntelliCred system for Medicare, Group Health and Quality Control and Administration teams for new hires, terms, location updates for clinician Medicare enrollment, external payer credentialing needs, APC Collaborative Agreements and DOT certification compliancy
Participate in acquisition activities for the department to include but not limited to launching workflows for all teams, updating all internal facility rosters and IntelliCred Group records
Maintain all departmental administrative tasks such as office supplies, incoming/outgoing mail, Fed Ex, department contact lists, etc.
Create and maintain internal Facility Listings on shared drive and Groups/Locations in database to include facility demographics, NPIs, legal entity, TIN, Medicare PTAN and billing information utilized by the department and for external Group Health payer needs. Prepare various reports such as custom facility listings and provider rosters as requested for internal and external clients
Track contracts for review and signature by executive leaders. Maintain all Group Health payer contract files via electronic and hard-copy file system
Reconciliation for Internal Credentialing verification charges. Obtain receipts for each transaction, validate and allocate the correct billing string for biweekly submission through the Concur expense reporting system