Credentialing Coordinator

Company: CAN Community Health
Location: Sarasota
Posted on: January 15, 2023

Job Description:

Description:

CAN Community Health, one of the nation's largest providers of HIV Services, has an exciting opportunity for a Credentialing Coordinator located at our corporate headquarters in Sarasota, FL. This position is a hybrid on-site and or work from home opportunity. Experience preferred but will train qualified candidates.

We are looking for someone who is passionate about serving the needs of individuals impacted by HIV and other infectious diseases. You will become part of our professional team that drives home our Company's Mission and Values. We offer good quality of life with an excellent schedule, competitive pay with a bonus plan, premiere benefits package with a retirement plan with a generous company matching contribution. We have received recognition in 2022, 2021, 2019, & 2018 NPT's Best Non-Profit to Work for Award.

CAN is a Drug-Free Workplace. All potential hires will be required to take and clear a pre-employment drug screen upon job offer.

Proof of COVID-19 Vaccination is preferred for this position.

Salary Range: $21 to $24/hour based upon education level, background, and experience.

You can find out more about us by visiting our website at www.cancommunityhealth.org. Apply Today!

Statement of Purpose: This position provides primary support to the Credentialing Supervisor and Revenue Cycle Management in all aspects of credentialing, re-credentialing, and contract management relative to CAN physicians, The Credentialing Coordinator will work directly with the CAN leadership to facilitate the credentialing, managed care enrollment, and any demographic changes for physicians and ancillary providers within the Clinical Group Practice. This individual may interact daily with physicians, practice administrators, billing vendors, commercial, and governmental health plans, and credentialing vendors. The coordinator is responsible for ensuring that accurate demographic information is submitted for health plan linkages and all credentialing related information is shared with all necessary stakeholders in an expeditious manner. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing.

Primary Tasks: Credentialing Coordinator
1. Updating Provider demographic data in credentialing system.
2. Work with the department leadership to proactively identify providers who will be joining the clinical group practice and establish appropriate service and billing information required for credentialing and payer enrollment.
3. Coordinate the submission of credentialing documents and demographic information to external vendor to initiate the credentialing and enrollment of providers into governmental and commercial health plans.
4. Communicate any possible barriers and delays in credentialing process to all necessary parties in a timely fashion.
5. Track and monitor the end-to-end enrollment process of providers from the preparation of contracts to the end point of successful confirmation of linkage to payers.
6. Prepare and distribute weekly updates of any new provider enrollments and demographic updates.
7. Correspond with health plans as needed to ensure the appropriate contract linkage on behalf of CAN providers.
8. Other task and projects as assigned, which support the credentialing and contract management business needs of the CAN clinical group practice.
9. Completing and submitting credentialing applications to managed care insurance companies, governmental plans (CMS Medicare PECOS & Florida Medicaid).
10. Assist clinical providers with CAQH applications on behalf of CAN employed providers.
11.Processes provider credentialing applications in accordance with accreditation standards, regulatory requirements, and policies and procedures.
12. Conducts thorough background investigation, research and primary source verification of all components of the application file.
13. Identifies issues that require additional investigation and evaluation, validates discrepancies and insures appropriate follow-up.
14. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
15. Maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
16. Tracks license and certification expirations for all providers to ensure timely renewals.
17. Promotes and practices CAN Community Health's mission and values and follows its policies and procedures.
18. Ensures confidentiality is maintained by CM team regarding patient/client information in accordance with HIPAA, professional and departmental standards.

Secondary Tasks: Credentialing Coordinator
1. Sets up and maintains provider information in online credentialing databases and system.
2. Maintains corporate provider contract files.
3. Perform all other duties as assigned.

Responsible To: Credentialing Supervisor

Requirements:
Education/Professional: Credentialing Coordinator
1. High School Diploma; Associate degree preferred.
2. 3- years or more Credentialing experience preferred.
3. Certified Provider Credentialing Specialist (CPCS) preferred or willing to obtain within 6-months of employment.

Knowledge, Skills and Abilities Required: Credentialing Coordinator
1. Proficiency in the use of Microsoft Office applications and internet resources.
2. Communicates effectively both orally and in writing.
3. Ability to analyze, interpret, and draw inferences from research findings, and prepare reports.
4. Ability to use independent judgement to manage and impart confidential information.
5. Excellent attention to detail.
6. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

Physical Requirements: Credentialing Coordinator
1. Neat, professional appearance.
2. SEDENTARY- Exerts up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly in lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time but may involve walking or standing for brief periods of time.
3. Requires expressing or exchanging ideas by means of spoken word, visual and auditory acuity.

CAN is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law

PI200399738

Keywords: CAN Community Health, Sarasota , Credentialing Coordinator, Other , Sarasota, Florida