Managed Care Credentialing Coordinator

3 weeks ago

Oak Brook, United States Advocate Health Full time

The Managed Care Enrollment Coordinator is a strategic role within managed care credentialing designed to facilitate the enrollment of Advocate Aurora Medical Group (AAMG) employed and contracted providers through all stages of onboarding in order to enroll them with commercial payers and works as a liaison to AAMG Operations/Contracting departments, AAH Payer Activation team and Advocate Physician Partners (APP).

Major Responsibilities:

  • Manages enrollment of all employed and contracted AAMG providers by applying subject matter expertise skills based on specific hiring/contractual arrangements to decide appropriate credentialing variables, demographics and service line.
  • Participate and/or request meetings with key contacts in AAMG to sort out appropriate credentialing route and enrollment processing of providers hired/contracted under a unique arrangement/contract. Collaborating with multiple departments/areas to streamline the above processes.
  • Adheres to deadlines and scheduled managed care credentialing committees by tracking files through all stages. Day-to-day responsibility for maintaining proactive communication with internal and external individuals regarding credentialing, enrollment and government payor activation processes.
  • Oversee receipt/review and processing of all practitioner demographic/specialty/other changes and resignation requests to be delivered to APP Network Management team for processing and distribution to commercial payers.
  • Communicate regularly via phone, fax, or written correspondence with Credentials Verification Office, Hospital medical staff offices, contract entities, physicians and group practice offices. Provide direct support to Managed Care
  • Credentialing coordinators in the processing of verifications and database maintenance of credentialing elements for new applicants and reapplicants. Also in tracking timely submission of recredentialing applications from AAMG
  • Data entry and record keeping of ancillary practitioners employed by AAMG. Track expirables of licensure, insurance and board certification for all AAMG practitioners credentialed members of APP.
  • Respond to internal/external questions and resolutions of problems relative to delayed, incomplete or problematic matters, specific to credentialing and provider enrollment according to established policies/procedures
  • Represent team in medical group AAMG Acquisitions team, AAH Payer Activation, Advocate Intensivists and Office of APC weekly meetings.


Education/Experience Required:

  • Level of Education: High School Graduate Years of Experience: Four (4) years' experience in administrative support position including database management.


Knowledge, Skills & Abilities Required:

  • Excellent communication, organizational and problem solving skills Advanced Proficiency in the use of Microsoft Office (Excel, Access, PowerPoint and Word) and credentialing software Knowledge of accrediting and regulatory agencies as related to the Medical Staff, including (but not limited to) Joint Commission, DNV, HFAP, CMS, OSHA, NCQA and State and Federal Law and other standards and regulations, and hospital and system-wide policies regarding licensed independent practitioners in the hospital setting required. Must have proven track record of effective interactions with physicians and other health care professionals Ability to work effectively and independently. Demonstrated ability to effectively manage multiple priorities
  • License/Registration/Certification: None


Physicial Requirements and Working Conditions:


This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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