Provider Enrollment Credentialing Coordinator 1

Mercyhealth Wisconsin and Illinois•Rockford, IL

2d•$21 - $33•Onsite

About The Position

The Provider Enrollment Credentialing Coordinator is responsible for understanding and maintaining in-depth knowledge of credentialing requirements for physicians and other healthcare providers with various third-party payers, including Medicare, Medicaid, and Blue Cross. This role involves implementing and obtaining National Provider Identifier (NPI) numbers, working collaboratively with internal departments to gather necessary information for timely credentialing, and managing all credentialing information within a designated system (e.g., CACTUS) to ensure accuracy, confidentiality, and timely re-credentialing. The coordinator also handles facility enrollment, investigates claims work queues, and communicates payer number information to ensure accurate billing. Additionally, this position involves developing and maintaining credentialing policies and procedures, educating partners on these policies, and participating in the Credentialing Committee.

Requirements

Associate's degree and 1 year of healthcare credentialing/enrollment experience preferred (healthcare facility, managed care setting, CVO, medical staff office, or enrollment), OR a minimum of 5 years of experience in credentialing (preferred), OR a minimum of 5 years of experience in a healthcare business support area required.
Three years' experience working with Wisconsin and Illinois Medicare and Medicaid credentialing regulations, plus managed care payers preferred.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Computer Skills: Knowledge of Patient Accounting software; Spreadsheet software and Word Processing software.
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Nice To Haves

CACTUS experience a plus.

Responsibilities

Maintain in-depth knowledge of credentialing requirements for Wisconsin and Illinois Medicare, Medicaid, Blue Cross, and other third payers.
Implement and obtain NPI numbers per provider.
Collaborate with Medical Staff Office, Clinic Directors, Clinic Finance, Information Systems, and physician recruiters to gather information for the credentialing process.
Understand and utilize government forms for credentialing physicians, physical therapists, CRNAs, Physician Assistants, and residents.
Investigate or follow up on claims work queues.
Understand and complete facility enrollment as appropriate.
Utilize systems like CACTUS to house and maintain credentialing information, including application submission dates, payer number receipt, and assigned numbers by location and payer.
Ensure confidentiality and accuracy of all credentialing information.
Initiate the re-credentialing process prior to expiration of current statuses/numbers.
Obtain and maintain information for credentialing Illinois physicians with each Mercy laboratory and the Illinois Department of Public Aid.
Process information on a timely basis and monitor expiration dates.
Complete forms/documents for obtaining provider numbers for Durable Medical Equipment (DME) as appropriate.
Monitor DME expiration dates and initiate re-certification.
Ensure all data in Cactus is current and personal information is kept confidential.
Communicate received payer numbers to a Patient Accounts Application Analyst for the McKesson Plus system.
Provide reports for the Credentialing Committee, Patient Accounts, and clinics.
Facilitate communication within Mercy Health System on the credentialing process as an active participant on the Credentialing Committee.
Develop, maintain, and implement policies and procedures to support the credentialing process.
Educate partners on the application of credentialing policies and procedures.