Credentialing Coordinator

• 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.
• Full-Time/Benefits Eligible
• Monday - Friday - 8am-5pm
• Westerville, OH

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.