Credentialing Administrator

Overview:

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Primary responsibilities include, but are not limited to, day-to-day support for the Contracting and Credentialing teams including launching of team workflows in the IntelliCred database; manage and track DOT and APC/ATC certification and compliancy; facility credentialing for Group Health payers; tracking of group health payer agreements/contracts for executive review/signatures; allocating and submitting expenses for internal credentialing verification charges.

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

Qualifications:

Education Level: High School Diploma or GED

Major:

Degree must be from an accredited college or university.

Education Details:

• A college degree in related field or equivalent work experience.

Certifications and/or Licenses:

Experience in lieu of required education is acceptable: No

Continuing education is required to maintain license and to perform job: No

Job-Related Experience

Customarily has at least the following experience:

2 years

• Customarily has at least 2 years of administrative skills experience

• Moderate to advanced Excel skills

Permanent