Credentialing, Privileging
1 week ago
Overview
The Credentialing, Privileging and Enrollment Coordinator (CPEC) is responsible for the credentialing, recredentialing, privileging and enrollment processes for medical and behavioral staff throughout the employee lifecycle to ensure client safety and high-quality care. They will maintain up-to-date data and files for each provider in agency systems. The CPEC is also responsible for assuring licensed staff are enrolled with affiliated medical insurances so that the organization can bill for services.
Key Role Responsibilities
- Conducts comprehensive initial and ongoing credentialing and privileging (c&p) of healthcare providers following industry standards and regulatory requirements. Maintains c &p files for all providers, ensuring accessibility and compliance with regulatory standards. Maintains thorough and organized electronic c & p files of current licenses, certificates, and trainings for all providers. Obtains and documents primary source verification and second source verification as required. Produces status reports and summaries regularly and upon request.
- Coordinates the provider enrollment process with Medicare, Medicaid, and commercial payers. Work in collaboration with the Revenue Cycle Team to ensure payer rosters are up to date with contracted providers. Works with individual providers to ensure each provider CAQH database files are updated timely according to the schedule published by CMS Medicare/ Medicaid and Managed Care Organizations regulation. Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available.
- Proactively engage with providers and departments to solicit, track, validate and store documentation and information. Tracks license and certification expirations for all providers to ensure timely renewals. Communicates with providers regularly to assist them with meeting these deadlines.
- Creates and maintains procedures and SOP to ensure the consistency of the credentialing, privileging and enrollment functions at the organization.
- Collaborates with the Quality division in regular internal audits. Participates in site or regulatory visits to provide documentation when required. Regularly self-audits files to ensure accuracy and compliance.
Key Agency Responsibilities
In addition to role responsibilities, every staff member has the following responsibilities as a part of their employment:
- Models and reinforces the core values of dignity, authenticity, hope, justice, passion and balance
- Actively participates in performance improvement and advocacy activities that support the mission
- Protects clients’ personal health information by maintaining compliance with HIPAA and other relevant health care-related IT security regulations
- Performs other duties on an as-needed basis
Knowledge, Experience, and Skills
Formal Education and Training
- Associate’s degree required; Bachelor’s degree preferred, preferably in HR, business or related field
- Certified Provider Credentialing Specialist (CPCS) OR Certified Professional Medical Services Management (CPMSM) preferred.
Experience
- Three years of administrative experience in a health care setting; two years in provider credentialing, privileging and/or enrollment.
- Experience working in a primarily digital (non-paper) based administrative environment
- Intermediate experience with Microsoft Office, as well as with data entry and report production from within an HRIS or similar system highly preferred
- Knowledge of credentialing and privileging requirements of government and accreditation bodies, preferably HRSA, NCQA and The Joint Commission
Skills
- Strong focus on process and procedures
- Passion for leveraging technology to reduce paper processes and create transparency
- Ability to work independently, with initiative, and problem-solve in a thoughtful, considered manner
- Ability to build and maintain strong relationships throughout the workplace and at all levels
- Understands how to conduct regulatory research to confirm best practices
- Operates with a sense of urgency with appreciation to tight deadlines
- Highly detail-oriented and organized, with accuracy and follow-through
- Sets clear goals, uses action plans and knows how to prioritize and manage projects
- Ability to work in sensitive situations with utmost discretion and maintain confidentiality
- Culturally sensitive working with individuals from diverse backgrounds
- Self-reflective and committed to creating an anti-racist workplace
Health Care for the Homeless is an equal opportunity employer and is committed to racial equity and inclusion. We make a particular effort to recruit and promote Black, Indigenous and People of Color (BIPOC) for open positions. BIPOC, LGBTQIA+ individuals, people with disabilities, and people with other marginalized identities are encouraged to apply.
This is a "flexible" position: At least 50% of position will be remote. General telework location must be within reasonable driving distance of our Baltimore-based offices.
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