Credentialing Coordinator
2 months ago
Administers the credentialing process to coordinate, monitor, and maintain facility and provider credentialing while supporting other department initiatives and projects. Analyzes and resolves problems related to physician enrollment and other activity for WVPHO members. Ensures that physicians are linked correctly to plans and products for correct claims payment and revenue. Responds to requests for verification and information from internal and external customers.
Responsibilities
•Follows up on physician enrollment status with contracted plans by building effective relationships with plan representatives to ensure that WVPHO member activities are given priority processing.•Evaluates reported claim problems to determine if problem is related to enrollment or other error. Resolves enrollment error, provides plan with documentation of error and obtains plan commitment to reprocess claims. Refers non-enrollment issues as appropriate.•Identifies data disparities between group contracted plan sources and Managed Care database to limit negative impact on revenue, precertification and referral denials and patient procedure cancellations. Works with plan representatives to correct errors.•Identifies delays in credentialing, enrollment errors and claims payment problems and works with plan representatives to further identify root causes and resolve problems.•Maintains internal database and external web module database; updates physician information in group contracted managed care plans, Medicare, Medicaid, and non-contracted carriers including demographic information, addresses changes and terminations.•Coordinates enrollment and credentialing for delegated and non-delegated plans, Medicare, and Medicaid including but not limited to enrollment, payer terming and demographic changes.•Follows organizational and regulatory requirements. Identifies potential problems. Proactively assists in problem resolution. •Provide world class customer service via phone, virtual and in person meetings and email correspondence•Ability to coordinate and complete multiple tasks, utilizing time management and organizational skills
Knowledge, Skills & Abilities
Patient Group Knowledge (Only applies to positions with direct patient contact)The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.Competency StatementMust demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.Common Duties and Responsibilities(Essential duties common to all positions)1. Maintain and document all applicable required education.2. Demonstrate positive customer service and co-worker relations.3. Comply with the company's attendance policy.4. Participate in the continuous, quality improvement activities of the department and institution.5. Perform work in a cost effective manner.6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.7. Perform work in alignment with the overall mission and strategic plan of the organization.8. Follow organizational and departmental policies and procedures, as applicable.9. Perform related duties as assigned.
Education
•Bachelor's Degree (Required)
Education: Bachelor's degree in business or healthcare administration.
Substitution: May substitute 4-5 years of credentialing and project management in a healthcare environment for the Bachelor's degree
Comment: •Demonstrated experience with database and supporting software including Microsoft Word, Excel and Microsoft Access. Able to perform essential functions for reporting purposes and data analysis (i.e., Create data, data sorting filtering for plan-database comparisons and reconciliations). •Excellent problem solving, communication and interpersonal skills to effectively mediate and resolve issues in a timely and cost-effective manner.•Demonstrated project management skills.•Demonstrated ability to prioritize workflow to achieve time sensitive goals.•Credentialing and/or Medical Staff Office experience preferred.•Strong project management skills.•Demonstrated human relations and effective communication skills.
Credentials
•No Certification, Competency or License Required
Work Schedule: Days
Status: Full Time Regular 1.0
Location: Northgate-400 Association Dr.
Location of Job: US:WV:Charleston
Talent Acquisition Specialist: Tamara B. Young tammy.young@vandaliahealth.org
-
Dietetic Internship Coordinator Position
4 weeks ago
Charleston, West Virginia, United States Compass Group USA Full timeJob Summary:We are seeking a Part Time Dietetic Internship Coordinator to oversee the dietetic internship students at MUSC in Charleston, SC.Key Responsibilities:Coordinates with the National Director on student recruitment, advisement, evaluation, and counseling.Develops and updates curriculum for accreditation and program improvement.Manages program...
-
Clinical Care Coordinator
4 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a key member of our healthcare team, the LPN Case Manager plays a vital role in enhancing the delivery of patient care services. Collaborating with healthcare professionals, this individual serves as a clinical resource to ensure high-quality patient care, efficient coordination of patient needs, and optimal patient...
-
Pharmacy Technician Quality Coordinator
4 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a Pharmacy Technician Quality Coordinator at CAMC Health System, you will play a vital role in ensuring the quality and safety of our pharmacy services. Under the supervision of the Director of Pharmacy, you will assist with the management of controlled substance acquisition, storage, and distribution. Your responsibilities will include...
-
Nurse Coordinator
4 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a Clinical Nurse 2 at CAMC Health System, you will play a vital role in coordinating and participating in the operations on an assigned shift and unit. This position requires the utilization of the nursing process to provide high-quality patient care and manage complex patients with minimal assistance.ResponsibilitiesPerform the duties and...
-
Nurse Coordinator
4 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a Clinical Nurse II, you will utilize the nursing process to coordinate and participate in the operations on an assigned shift and unit. This role is accomplished within a customer service and continuous quality improvement framework.ResponsibilitiesPerform the duties and responsibilities of a clinical nurse II.Patient Care:Demonstrates...
-
Travel Experience Coordinator
1 month ago
Charleston, West Virginia, United States Destinee Travel Full timeJob Title: Remote Travel PlannerAt Destinee Travel, we're seeking a skilled Remote Travel Planner to join our team. As a key member of our customer service team, you'll be responsible for assisting clients in planning and handling arrangements for their travel experiences.Key Responsibilities:Client Consultation: Engage with clients to understand their...
-
Pharmacy Technician Quality Coordinator
1 month ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a Pharmacy Technician Quality Coordinator at CAMC Health System, you will play a crucial role in ensuring the efficient management of controlled substance acquisition, storage, and distribution. Under the supervision of the Director of Pharmacy, you will be responsible for overseeing the collection and review of controlled substance data to...
-
Clinical Nurse II
3 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a Clinical Nurse II, you will utilize the nursing process to coordinate and participate in the operations on an assigned shift and unit within a customer service and continuous quality improvement framework.ResponsibilitiesPerform the duties and responsibilities of a clinical nurse IIPatient Care: Demonstrate consistent use of nursing process...
-
Neurological Surgeon
4 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a Neurological Surgeon with CAMC Health System, you will provide diagnostic and surgical services to patients in the field of Neurosurgery. This role requires a high level of expertise and a commitment to delivering exceptional patient care.ResponsibilitiesProvide care to CAMC patients in the field of Neurosurgery.Collaborate with the CAMC...
-
EM locum need in SC
2 weeks ago
Charleston, United States All Star Recruiting Full timeAll Star Healthcare Solutions is seeking an Emergency Medicine physician to assist with locums coverage in South Carolina. Job details include: Coverage starts upon credentials Night and Swing Shifts SC License Board Certified/Board Eligible - must be ABEM All Star Healthcare Solutions benefits Competitive pay Malpractice coverage Full-service agency...
-
Nurse Case Manager
1 month ago
Charleston, South Carolina, United States Lancesoft INC Full timeJob SummaryWe are seeking a skilled Nurse Case Manager to join our team at Lancesoft INC. As a key member of our healthcare staff, you will be responsible for providing high-quality patient care and coordinating services to ensure optimal outcomes.Key Responsibilities:Assess patient needs and develop individualized care plansCoordinate with healthcare...
-
Office Manager
7 days ago
Charleston, United States Charleston Comprehensive Treatment Center Full timeOverviewSeeking: Office Manager - Outpatient Addiction Recovery Full-Time Hours: Monday - Friday 4:45 AM - 1:15 PM Our Benefits: Quarterly Bonus Program Medical, Dental, and Vision insurance Competitive 401(k) plan Paid vacation and sick time STAR LRP Student Loan Forgiveness Early morning hours offering a great work/life balance Opportunity for growth...
-
Office Manager
24 hours ago
Charleston, United States Charleston Comprehensive Treatment Center Full timeOverviewSeeking: Office Manager - Outpatient Opioid Treatment Program Full-Time Hours: Monday - Friday 4:45 AM - 1:15 PM Our Benefits: Quarterly Bonus Program Medical, Dental, and Vision insurance Competitive 401(k) plan Paid vacation and sick time STAR LRP Student Loan Forgiveness Early morning hours offering a great work/life balance Opportunity for...
-
Charleston, West Virginia, United States MUSC Health & Medical University of SC Full timeJob SummaryProvide administrative support to the Orthopaedics department, including faculty, senior staff, and advanced practice providers.Key ResponsibilitiesAdministrative Support: Coordinate meetings, communicate with members regarding physician availability and scheduling, and maintain calendars.Reimbursement and Records: Compile physician reimbursement...
-
Oral and Maxillofacial Surgeon
4 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs an Oral and Maxillofacial Surgeon with CAMC Health System, you will provide diagnostic and surgical services to patients in compliance with the highest standards of medical art and science. Your care will be delivered in the appropriate setting and coordinated with the staff, ensuring a seamless patient experience.ResponsibilitiesDeliver...
-
Critical Care Physician
1 month ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryUnder indirect supervision, provides and manages direct health care for a specified patient population.ResponsibilitiesProvides and manages direct patient care, including physical examinations, evaluations, assessments, diagnoses, and treatment for a specified patient population.Prescribes pharmaceuticals, other medications, and treatment regimens...
-
Early Childhood Educator
3 weeks ago
Charleston, Missouri, United States DAEOC Full timeJob SummaryThe Child Family Advocate will be responsible for the care and educational development of children ages 0-3 and engage their families in accordance with Federal Head Start Performance Standards.Key ResponsibilitiesCommunicate effectively with families and coordinate with local resource providers to help with the needs of the families.Work as a...
-
Nurse Leader
4 weeks ago
Charleston, West Virginia, United States CAMC Health System Full timeJob SummaryAs a Charge Nurse 3 at CAMC Health System, you will utilize the nursing process to coordinate and participate in the operations on an assigned shift and unit. This role is accomplished within a customer service and continuous quality improvement framework.ResponsibilitiesPerform the duties and responsibilities of a clinical nurse III Patient Care:...
-
Cardiac Rehabilitation Manager
4 weeks ago
Charleston, West Virginia, United States Herbert J. Thomas Memorial Hospital Association dba Thomas Hospitals Full timeJob Title: Cardiac Rehabilitation ManagerWe are seeking a highly skilled and experienced Cardiac Rehabilitation Manager to join our team at Herbert J. Thomas Memorial Hospital Association dba Thomas Hospitals. The successful candidate will be responsible for coordinating and managing the cardiac rehabilitation program, ensuring that patients receive...
-
Pulmonary Critical Care Per Diem
7 months ago
Charleston, United States CAMC Health System Full timeJob Summary Provide Pulmonary Disease/Critical Care Services to the patients of Charleston Area Medical Center, Inc. and its affiliates per the terms of the employment agreement. Responsibilities To provide care of CAMC patients in the field of Pulmonary Disease/Critical Care in compliance with the highest standards of medical art and science as per...
