Credentialing Coordinator - Urgently Hiring

Clinical Associates•Towson, MD

1d•Onsite

About The Position

At Clinical Associates , we make being healthy easier. We connect our patients to a seamless system of integrated medical care, which includes in-house specialists in areas of practice, from cardiology to podiatry. We also offer unique services like our nuclear stress testing facility. Our physicians, specialists and credentialed health care providers are assisted by 175 trained support staff. We do our best to take care of everything for our patients –medical records, scheduling appointments, coordinating with providers and specialists, and each of our offices has laboratory centers for tests and blood work on site. We are seeking to add an experienced Credentialing Coordinator to our Corporate Office in Towson! Our ideal candidate must be a team player, with the ability to work efficiently in a fast paced environment. Working under the supervision of the Billing Manager, the primary function of the Credentialing Coordinator is to ensure that all critical credentialing tasks are completed in a timely manner and meet set goals in establishing and maintaining valid and current affiliations for all providers with facilities and insurers.

Requirements

Bachelor’s Degree. Will consider non-degreed candidates with significant relevant experience of at least 2 years with hands on credentialing of providers.
Extensive familiarity with insurance carriers’ credentialing requirements.
Computer literate (Excel, Nitro, Access) with a willingness and ability to learn new applications.
Knowledge of Credentialing databases and other software programs to include CAQH, NPDB, e-PREP, NPPES and PECOS.
Experience with checking provider status in various databases, such as NPPES, CDS, DEA, OIG, Medicare, NPDB, etc.
Excellent oral communication skills with ability to hear and to speak standard English clearly and concisely.
Excellent written communication skills with ability to read, write and spell standard English clearly and concisely.
Ability to interact effectively with culturally diverse patient, practitioner, and employee population.
Ability to convey a positive attitude and project a professional image.
Ability to remain flexible and manage multiple tasks and priorities.
Ability to maintain confidentiality.
Ability to maintain reliable attendance.
Requires long periods of sitting, intermittent standing, reaching, and bending.

Nice To Haves

CPCS certification preferred.
Knowledge of EMR systems - Nextgen is a plus!

Responsibilities

CREDENTIALING/PAYOR ENROLLMENT: Perform all duties related to credentialing/re-credentialing and enrollment of payors for initial and current providers.
Provide credentialing application to all newly hired providers, assist with completion of all applications, and needed documents with timely return for processing.
Perform all duties related to provider departure including notification to payors and hospitals.
Verify all credentials and malpractice claims through the state licensing board and other PSV sources.
On an ongoing basis, remind providers when licenses require renewal.
Assure applications are processed within a thirty-day processing time frame.
Coordinate all credentialing-related appointments with the hospital.
Facilitate the reappointment process for hospital privileges.
Maintain/update physical credentialing files for each provider.
Maintain all credentialing databases such as CAQH, NPDB, NPPES, PECOS, e-PREP and other identified databases.
Provide updated licensing and other pertinent documentation to hospitals as required to maintain privileges.
Complete check requests for hospital fees/dues.
Work with payors to ensure accurate information is reflected for Clinical Associates’ providers.
Act as liaison between administrative staff of Clinical Associates and the payors in resolving credentialing issues for physicians.
MALPRACTICE: Request malpractice insurance for newly hired providers as appropriate.
Request claims history from malpractice company as needed.
Perform all administrative duties as related to renewal of malpractice insurance for the company.
Process tail coverage for all departing providers following policies of the malpractice insurance company and Clinical Associates.
Provide copies of malpractice face sheets to appropriate entities as needed.
CONTRACTING: Facilitate payor contracts.
Initiate and renegotiate MCOs and small to medium commercial payor contracts for Clinical Associates.
ADMINISTRATIVE DUTIES: Assists in troubleshooting claims being denied payment by the insurers.
Assist Billing Manager in any assigned duties or projects.
Address billing tasks related to credentialing issue denials.
Scan and send billing documents to NextGen.
Back up Charge Entry staff.
Assist Managers and staff with Payor participation questions.
All other duties as assigned