Credentialing Coordinator

Central Ohio Primary Care is seeking a Credentialing Coordinator at their Central Business Office in Westerville, Ohio. The Credentialing Coordinator provides administrative and credentialing support to physicians and other non-physician practitioner types in a 560+ multi-specialty provider group practice. This position communicates regularly with Physicians, Providers and leadership to ensure timely and accurate credentialing. This is a full time, benefits eligible position working Monday- Friday 8-5p.

Duties/Responsibilities:

- Complete initial and recredentialing applications for provider enrollment for health plans and hospital memberships in accordance with payor guidelines, government regulations and standard operating procedures.

- Review applications for completeness and signature prior to submission to health plan or CVO/hospital medical staff office.

- Input and update provider credential databases of CAQH, PECOS, NPPES, & ECHO.

- Maintain knowledge of current health plan and hospital membership requirements for credentialing providers.

- Track and maintain copies of current state licenses, DEA certificates, Board Certification, malpractice coverage and any other required credentialing documents for all providers.

- Audit health plan directories for current and accurate provider in formation.

- Perform extensive follow-up with health plans to expedite participation approval to maximize billing opportunities and reduce risk of claim adjustments.

- Interact with Administration, Legal, Revenue and other internal departments to obtain required documentation and information necessary for the credentialing process of providers

- Timely and accurately maintains detailed enrollment status notes, provider numbers and effective dates and files in the provider enrollment databases.

- Notify Revenue Department and practice sites reps of the status of newly enrolled providers by health plan name to assist with scheduling needs and the release of billing claims on hold.

- Identify emerging issues and communicate to provider team lead and/or manager with recommendations for resolutions.

- Respond to, research, and resolve problems with provider network participation as it relates to payment denials by working with internal staff, practice sites within the company and health plans.

- Provide support to practice site personnel as it relates to provider participation with various managed health care plans and 3rd party administrators.

- Responsible for researching, monitoring, and communicating health plan enrollment/re-enrollment policies and procedure changes. Effectively communicates proposed changes and ensures proper system set-up.

- Adheres to departmental policies and procedures.

- Performs other duties as assigned.

Education, Licensures & Certifications

- Required: High School Diploma or Equivalent

- Preferred: 2-3 years medical credentialing

- Required: Knowledge of health plan enrollment with Managed Care Plans and Governmental/State Plans, Medicare, Medicaid and Workers’ Compensation

Knowledge, Skills & Abilities

- Strong analytical and problem-solving skills.

- Excellent organization skills with the ability to prioritize assigned duties in an efficient amount of time

- Strong communication and interpersonal skills

- Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and Adobe Acrobat

- Ability to effectively use oral and written communication skills with internal staff and external agencies and management in a courteous and professional manner

- Ability to pay close attention to detail and produce extremely accurate work

- Ability to effectively perform in a multi-task work environment

- Ability to maintain patience and composure in difficult situations

- Ability to work well under pressure and meet deadlines

- Ability to maintain confidentiality

- Ability to exhibit a commitment to teamwork, supporting alignment with company and department goals and objectives

- Ability to work independently within scope of responsibility

- Knowledge of state and health plan requirements