Human Resources Coordinator/Credentialing Specialist

Jordan Valley Health•Springfield, MO

10h

About The Position

About Jordan Valley Health: Jordan Valley Health (JVH) is a mission-driven organization dedicated to improving the health of individuals and families in underserved communities. We provide comprehensive healthcare services including primary medical, dental, vision, and behavioral health. Our mission is simple: Improve our community’s health through access and relationships. By working collaboratively with partners and continually innovating, JVH strives to be a leader in providing essential healthcare for the underserved, ensuring everyone in our community has access to quality healthcare. Job Summary: The Credentialing Specialist/HR Coordinator will support the organization in the following functional areas: new hire process and onboarding, HRIS, training and development, organization development, administration, credentialing, and employment activities. This role is responsible for all aspects of credentialing, re-credentialing and privileging processes for all medical, dental and behavioral health providers. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans for all relevant Jordan Valley locations and local hospitals as appropriate. Maintain up-to-date data for each provider in credentialing databases and online systems; and ensure timely renewal of licenses and certifications.

Requirements

Associate degree required, Bachelor’s Degree preferred in HR, management, business, social work, or related field.
One to three years’ experience in human resources
One to three years’ experience in medical staff services/work
Must have Microsoft Office experience.
Excellent organizational, communication, and judgment skills a must.

Nice To Haves

Insurance Credentialing experience preferred.

Responsibilities

Manages the credentialing process from start to finish including obtaining applications from the payers, completing applications accurately, submitting applications timely per policy or within a reasonable time frame to avoid delays, complete regular follow-up with the payers to ensure applications are being processed, and obtaining contracts once the credentialing process is completed.
Manages the hospital privileging process from start to finish, coordinates all documents and meetings required, and follow up with the hospitals to ensure privileges are obtained.
Perform Primary Source Verification (PSV) services including but not limited to verification of licenses, DEA, BNDD, malpractice, work history, and professional references.
Maintain a working knowledge of payer credentialing and re-credentialing policies and procedures.
Create urgency with providers and facilities via email and phone, to encourage timely and accurate document submission by establishing target dates and monitoring document submission progress.
Develop and follow best practices in credentialing and re-credentialing.
Work directly with administrative contacts and customers which includes: performing regular updates and communicating clearly on the status of the enrollment process to customers and contacts as designated by the customer, or director on a regular basis.
Maintain a company wide database in accordance with Jordan Valley Health policies and procedures for all participating and non-participating providers with payer identification numbers and effective dates.
Respond to various inquiries from participating physicians, staff, hospitals, and payers timely and with professionalism. Provide superior customer service at all times to internal and external contacts including customers, providers, representatives, and other staff.
Monitors the program for compliance with external review agencies and maintains compliance with Federal, State and Local regulatory bodies.
Maintains knowledge of current health plans and agency requirements for credentialing providers.
Has access to collaborative practice agreements for medical mid-level providers for payer enrollment.
Assists with the on-boarding process of Medical, Dental, and Behavioral Health providers as related to payer enrollment and duties assigned for onboarding the Provider.
Serve as Government and Commercial Insurance Provider Relations liaison. Provide updates as required.
Follows all organizational and departmental policies and procedures in the performance of all job duties to ensure a safe work environment for self and others.
Coordinates process from applicant to new-hire by completing hiring process in HRIS system
Coordinates initial credentialing for new providers and re-credentialing for current providers.
Ensure the timely completion and submission of required compliance with all existing governmental and labor reporting requirements.
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
Maintains knowledge of current health plan and agency requirements for credentialing providers.
Works with credentialing team to maintain provider information in online credentialing databases and system.
Follows all organizational and departmental policies and procedures in the performance of all job duties to ensure a safe work environment for self and others.
Advises employees and managers about proper HR policies and procedures.
Responds to calls and visits from employees, managers, and others and determines the priority of the situation. Suggests appropriate actions. Answers telephones, prioritizes, screens, and redirects calls. Answers questions, handles routine matters, and takes messages.
Prepares employment verifications, requests, and reports for employees and former employees or agencies.
All other duties as assigned

Benefits

Medical and Prescription Drug Coverage: Three comprehensive plan options (Buy-up, Base, and High Deductible) through UnitedHealthcare's Choice Plus network, covering various deductibles and out-of-pocket limits. Includes access to telemedicine services via Teladoc.
Health Savings Account (HSA): Available for employees in the High Deductible Plan with employer contributions and tax advantages.
Flexible Spending Account (FSA): Options for both healthcare and dependent care FSAs, allowing pre-tax contributions for qualified expenses.
Dental and Vision Coverage: Dental insurance through Cigna’s DPPO network and vision coverage through EyeMed’s Insight network.
Retirement Plan: Pre-tax and Roth 403(b) retirement plans with a 5% employer match starting after 30 days of employment.
Life and Disability Insurance: Basic Life and AD&D insurance provided at no cost, with the option to purchase additional coverage. Long-term and short-term disability insurance are also available.
Employee Assistance Program (EAP): Free confidential support for personal and professional challenges, including counseling and crisis intervention.
Additional Voluntary Benefits: Options for critical illness, accident, hospital care, and pet insurance through MetLife.
Pay on Demand Available
Holidays: Nine paid holidays per year.