Credentialing Coordinator Lead

4 weeks ago

Lockport, New York, United States Orthopedic One Full time
Job Summary: We are seeking a highly skilled Credentialing Coordinator Lead to join our team at Orthopedic One. The successful candidate will be responsible for maintaining provider credentials and ensuring timely and accurate filing of credentials for insurance and hospital contracting. This role requires strong leadership skills, attention to detail, and excellent communication skills.

Key Responsibilities:
  1. Coordinate and lead the credentialing team in all physician and resource credentialing with hospitals, medical boards, and credentialing vendors.
  2. Demonstrate strong communication skills with hospital medical staff offices, insurance payers, and physicians.
  3. Communicate with providers to advise of renewal of licensure and certification updates.
  4. Maintain PECOS and payer websites for physicians and advance practice providers.
  5. Provide weekly and ongoing credentialing update communications to operations regarding changes to the credentialing status of new providers.
  6. Perform other administrative tasks at the request of management as related to credentialing and board certification documentation.
  7. Provide guidance, education, and workflow efficiencies for all aspects of credentialing, enrolling, and privileging of Orthopedic One billable providers.
  8. Communicate with payer provider representatives to ensure group contracts and fee schedules are maintained and kept up to date.
  9. Assist with payer contract negotiations and ensure claims are adjudicated per our payer contracts.
Customer Service and Communications:
  1. Communicate with patients, insurance carriers, and other outside entities in a professional manner.
  2. Identify solutions and respond professionally to patient concerns.
  3. Diffuse negative situations with patients and maintain a pleasant and professional tone during stressful circumstances and heavy workload.
Teamwork:
  1. Work cooperatively with coworkers, providers, and management.
  2. Share knowledge and insights with coworkers in a constructive manner.
  3. Volunteer to cover time off or unexpected absences and maintain workflow in the department without direct supervision.
  4. Address conflicts with the person directly before involving a manager or uninvolved peers.
  5. Be considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in the department.
Policies and Procedures:
  1. Know and comply with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
  2. Provide assistance and support to leadership in implementing policies and procedures as necessary.
  3. Actively participate in training and conduct day-to-day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.
Requirements:
High School Diploma or equivalent required. A minimum of five years of work experience with healthcare provider credentialing is required. Knowledge of revenue cycle functions and healthcare experience is also required.

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