Credentialing Coordinator

Central Ohio Primary Care Physicians is seeking a Credentialing Coordinator at their Central Business Office in Westerville, Ohio. The Credentialing Coordinator provides administrative and credentialing support to physicians and other non-physician practitioner types in a 560+ multi-specialty provider group practice. This position communicates regularly with Physicians, Providers and leadership to ensure timely and accurate credentialing. This is a full time, benefits eligible position working Monday- Friday 7:30am-4:00pm.

Duties/Responsibilities:

• Completes initial and re-credentialing applications for provider enrollment for health plans and hospital memberships in accordance with payor guidelines, government regulations and Standard Operating Procedures.
• Review applications for completeness and signature prior to submission to health plan or CVO/hospital medical staff office.
• Inputs & updates provider credential databases of CAQH, PECOS, NPPES, & ECHO.
• Maintains knowledge of current health plan and hospital membership requirements for credentialing providers.
• Tracks and maintains copies of current state licenses, DEA certificates, Board Certification, malpractice coverage and any other required credentialing documents for all providers.
• Audits health plan directories for current and accurate provider information.
• Performs extensive follow-up with health plans to expedite participation approval to maximize billing opportunities and reduce risk of claim adjustments. Acts proactively and builds strong relationships with health plans to facilitate the enrollment process.
• Interacts with Administration, Legal, Revenue and other internal departments to obtain required documentation and information necessary for the credentialing process of providers.
• Notifies Revenue Department and practice sites reps of the status of newly enrolled providers by health plan name to assist with scheduling needs and the release of billing claims on hold.
• Responds to, researches, and resolves problems with provider network participation as it relates to payment denials by working with internal staff, practice sites within the company, and health plans.
• Provides support to practice site personnel as it relates to provider participation with various managed health care plans and 3rd party administrators.
• Responsible for researching, monitoring and communicating health plan enrollment/re-enrollment policies and procedure changes. Effectively communicates proposed changes and ensures proper system set-up.
• Works independently within scope of responsibility and authority. Understands and follows rigorous state and health plan requirements, determines task priorities and escalates enrollment requiring manager approval or special processing requirements.
• Performs other duties as assigned.

• High school diploma or equivalent.
• 1-3 years of prior medical credentialing preferred, but not required.
• Knowledge of health plan enrollment with managed care plans and governmental/state plans, Medicare, Medicaid and workers' compensation.

• Strong analytical and problem-solving
• Excellent organization skills with the ability to prioritize assigned duties in an efficient amount of time
• Strong communication and interpersonal skills
• Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and Adobe Acrobat
• Ability to effectively use oral and written communication skills with internal staff and external agencies and management in a courteous and professional manner
• Ability to pay close attention to detail and produce extremely accurate work
• Ability to effectively perform in a multi-task work environment
• Ability to maintain patience and composure in difficult situations
• Ability to work well under pressure and meet deadlines
• Ability to maintain confidentiality
• Ability to exhibit a commitment to teamwork, supporting alignment with company and department goals and objectives
• Ability to work independently within scope of responsibility
• Knowledge of state and health plan requirements