Credentialing Coordinator

7 days ago

Gainesville, Georgia, United States Northeast Georgia Health System, Inc Full time
About the Role

This position is responsible for performing day-to-day duties and tasks related to the credentialing of practitioners and facilities to participate with the Health Partners (HP) Network.

Key Responsibilities
  • Process initial appointments and re-appointments for practitioners and facilities, ensuring compliance with established eligibility criteria and completeness of supporting documentation.
  • Credential practitioners and facilities according to NCQA standards and the approved Health Partners credentialing program.
  • Conduct primary source verification of credentials, including licensure, licensure sanction activity, DEA certificate, work history, professional liability insurance, education, training & board certification, hospital privileges, and disciplinary action history.
  • Initiate contact with applicants and their staff for orientation and educational purposes, and schedule meetings to facilitate the on-boarding process.
  • Coordinate activities related to the Health Partners Credentials Committee, including preparation and distribution of Credentialing Committee reports.
  • Participate in Credentials Committee meetings, take minutes as assigned, and draft and distribute them to committee members for review and approval.
  • Coordinate and process the entry of credentialing-related information into the appropriate software application in a timely and accurate fashion.
  • Track timeliness of provider loads by payer, including date submitted, date confirmation received, error rate, and corrections needed.
  • Audit provider loads once confirmed by the payer for accuracy, report errors to the payer, and monitor progress and resolution.
  • Monitor receipt of payer effective date notices, contact payers to follow up on enrollment status, secure provider numbers, effective dates, and confirmation letters.
  • Participate in the quarterly demographic update process and follow up as deemed necessary.
  • Take the lead with payers in monitoring the progress of payer enrollment for NGPG providers, notify management of payer noncompliance, and resolve any issues that may arise.
  • Enter and update all NGPG provider demographics into hospitalist group database for tracking and reporting purposes.
  • Actively participate in the NCQA accreditation process, including preparation, submission, and on-site survey.
  • Act as a liaison between the Health Partners, providers, employers, payers, and Medical Staff Services (Central Verification Office).
  • Assist with invoicing and collecting the annual HP participation fees from providers.
  • Maintain regulatory compliance and promote quality customer service, ensuring provider satisfaction issues regarding noncompliance with credentialing program are investigated, reported, and appropriate action is taken to resolve the issue.
Requirements
  • Licensure or other certifications: Bachelor's Degree
  • Minimum Experience: Minimum two (2) years credentialing experience in a managed care organization, hospital, or physician environment
  • Preferred Licensure or other certifications: CPCS certification
  • Preferred Experience: Knowledge of NCQA standards
Working at Northeast Georgia Health System

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

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