Credentialing Coordinator

Overview:

PROVIDER CREDENTIALING &RECREDENTIALING & ENROLLMENTS:

Obtaining, verifying, entering, and storing provider credentials within established timeframes and quality standards.

• Ensuring required credentials are received for initial credentialing and re-credentialing.
• Save credentials in established folders and uploading into Verity Stream(Credential Stream) as appropriate.
• Data-enter credentials, payers, payer e?ectivedates, and other pertinent information, as appropriate.
• Identify and forward to appropriate Coordinators items that need their attention.
• Enrolling providers to the appropriate insurers.
• Actively working to receive and document status and e?ective dates in Verity Stream (Credential Stream), Monday Board software, Issue Trak (ticketing system used internally), and other tools/software, as needed.
• Responding to re-credentialing requests with required credentials per payer.
• Store welcome letters/emails in the appropriate folder and upload into Verity Stream(Credential Stream) for each payer entry.
• Monitor and update Monday Boards, Issue Track, and Provider Rosters related to credentialing or enrollment without being asked.
• Notify o?ces of e?ective dates from each payer (forward welcome letters/emails or advise them directly from you).

CUSTOMER SERVICE/TROUBLESHOOTING:

Working interdepartmentally and externally to address issues with provider set-up, EOB research, and related information.

• Actively address issues reported with payments that may not be at expected reimbursement levels.
  • Determine if theres an issue with the providers network status with the payer versus whats in Verity Stream (Credential Stream) and showing at the o?ces PMS system.
  • Determine if there is an issue with the proper fee schedule being attached by the payer.
  • Seek reprocessing claims at the payer level to support the o?ce and avoid having to resubmit (where possible).
• Approach each reported issue from the perspective of providing excellent customer service professional communications and addressing issues from a customer service perspective.
  • Actively help others troubleshoot issues, especially where you may have some additional knowledge (e.g., an o?ce was previously owned by you).

PARTNERING WITH OFFICES/PROVIDERS:

Demonstrate a sense of ownership and pride in working with your assignedo?ces to facilitate a positive impact in working with the credentialing department.

• Oversight of assigned o?ces/providers; providing timely, courteous, and thorough support.
• Provide consistent and timely follow-up on all outstanding items for our o?ces.
• Build an ongoing, collaborative rapport with o?ce sta? and providers.
• Ensure requests are bundled and communications appropriate (e.g.: update/request items appropriately).

FEE SCHEDULE MAINTENANCE:

Working interdepartmentally and externally to ensure appropriate fee schedule attachment (to provider records with payers) and updating into o?ce practice management systems.

• During provider enrollment, ensure the insurer attaches the appropriate fee schedule (e.g., mirroring other providers or, if a speci?c schedule, obtaining the schedule and notifying payers, per the current process).
• Monitor, update, and process fee schedule updates from Monday Board software and emails proactively.
• Work with Payer Strategy after the negotiation process to ensure new fee schedules received are attached to providers (notify payers, as the process may indicate).
• Store fee schedules in the appropriate folder with the proper names
• Update o?ce PMS systems accurately and within established timeframes.

REQUIREMENTS:

• High school diploma or equivalent.
• 1+ years of job experience preferred:
  • Dental or health experience is a plus, but it is not required.
  • Dental or health insurance enrollment/credentialing experience (PPO/HMO/Medicaid, EPO, DiscountPlans, etc.) is preferred but not required.
• Pro?cient with MicrosoftO?ce (Word, Excel & Email Outlook), Adobe Pro, and an ability to learn new computer applications.
• Verity Stream credentialing software experience is a plus but not required.

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