Credentialing Coordinator

7 days ago

Saint Petersburg, United States Johns Hopkins All Children's Hospital Full time

**At Johns Hopkins All Children's Hospital we offer an excellent Benefits Package, to include**:

- Affordable healthcare
- Paid Time Off (PTO) and company paid holidays
- Tuition Assistance
- Life and disability insurance
- Opportunities for career development
- Employee discount program - travel, tickets, dining and more

***:
Works under mínimal supervision specifically with Medical Staff Credentialing specialists and Managed Care and Billing on issues and processes which directly impact Provider Plan Enrollment (PPE) and Billing. Initiates communication with Managed Care department in order to monitor and resolve third party billing and compliance issues. Acts as liaison and support staff for the Council for Affordable Quality Healthcare (CAQH) initiative. Works with Administrators, Providers and Office Staff to ensure compliance with CAQH requirements and mandates by third party groups. Performs special projects while taking an active role as a departmental liaison in the implementation of policies and procedures which affect revenue cycle and other clients.

Hours: Full Time/40 Hours Per Week

Location: St. Petersburg, FL

**KEY ACCOUNTABILITIES**:
1. Responsible for the timely enrollment into managed care organizations, government payers and out of state plans for new or employed physicians and for ongoing maintenance of existing providers
2. Responsible for data entry of provider enrollment information into Provider Enrollment Database systems (Apogee) and distribution of information to designated department representatives
3. Accountable for all aspects of provider enrollment to ensure provider data is loaded appropriately in all relevant systems including understanding and communicating unique arrangements; ensures the third party payers accurately credential the provider
4. Accountable for directly entering and updating provider data in the CAQH system; follows up with managed care organizations to ensure expedient credentialing; performs reviews of new enrollment files for deficiencies and pursues incomplete information with practice contact or provider
5. Responsible for the on-going maintenance of existing providers including, but not limited to, the submission of maintenance forms to update personal and practice demographic data for providers and billing updates
7. Responsible for follow-up and resolution of payer denials related to enrollment/credentialing; works closely with the billing department
8. Manages compliance with delegated plan agreements; responsible for submission of monthly/quarterly reports as directed by the plan; ensures compliance with designated policies, procedures and standards

**QUALIFICATIONS**:

- Associate’s degree in a related field
- 2 years’ experience in hospital or managed care environment with knowledge and understanding of medical staff service principles, methods and procedures and credentialing and privileging processes
- Excellent interpersonal and communication skills and the ability to interact effectively with a variety of individuals and groups, including medical staff, area health professionals, vendors, technical staff, business leaders and members of the general public
- Ability to work independently; develop, plan and implement short and long range goals; and to prioritize and implement multiple projects
- Working knowledge of federal and state regulatory requirements and accreditation standards, including Joint Commission, NCQA and CMS; working knowledge of state and federal laws relating to due process and provisions of the Health Insurance Portability and Accountability Act of 1996 and all applicable standards

We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.

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