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Credentialing Specialist/Coordinator

1 month ago

Worcester, Massachusetts, United States Family Health Center Full time
Credentialing Specialist/Coordinator

The Family Health Center is seeking a highly organized and detail-oriented Credentialing Specialist/Coordinator to join our team. This role is responsible for maintaining active status for all providers by successfully completing initial and subsequent Re-Appointment and Re-Credentialing packages as required by the Health Center and for our admitting hospital (UMass), our commercial payers, Medicare and Medicaid.

Responsibilities:
  • Provider OnBoarding (Privileging/Credentialing):
    • Initial Contact/Support to Provider's with Privileging & Credentialing process at acceptance of employment
    • Initiate Provider Hospital Credentialing for Physicians, collaborate w/UMass to maintain Physician Hospital Appointments
    • Maintain internal provider ID's roster to ensure all information for Provider's is accurate and logins is available (NPI/PECOS access)
    • Complete/Provide support to providers in Applying for and renewing provider licenses; Professional, DEA, Controlled Substance, and any other required supporting documentation to practice medicine.
    • Perform all Primary Source Verifications as required by CMS/HRSA/Joint Commission/NCQA for all Health Care Professionals at initial and Re-Appointments of all LIP's.
    • Facilitate/Support providers in signing up and/or obtaining compliance trainings, CME's, Life Support Trainings when due
    • Re-Credential providers as required for both the Health Center and for UMass
    • Board-Provider List
    • Board Letters
    Credentialing Compliance:
    • Maintain accurate provider credentialing profiles in (Cactus) Cred software.
    • Track and Report Monthly on all Credentialing Expirables
    Provider Health Plan Enrollment (Revenue Cycle):
    • Complete revalidation requests issued by both MassHealth and PECOS for all providers.
    • Complete credentialing applications to enroll providers to commercial payers, Medicare, and Medicaid
    • Track/Report Provider enrollment progress
    • Initiate and Maintain each provider's CAQH database file timely and according to the schedule published by CMS
    • Complete re-credentialing applications for commercial payers
    • Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
    • Create/Maintain accurate provider profiles on online profiles in CAQH, PECOS, NPPES, MassHealth/C3 and CMS databases
    • Other duties as assigned
    Knowledge, Skills and Abilities:
    • Knowledge of provider Credentialing & Provider Enrollment and its direct impact on the practice's revenue cycle
    • Excellent computer skills including Excel, Word, and Internet navigation for State, Federal sites and healthplan searches
    • Detail oriented with above average organizational skills, and time management
    • Plans and prioritizes to meet deadlines
    • Excellent customer service skills; communicates clearly, effectively and professionally
    Education and Experience:
    • High School Diploma, GED, Associates /Bachelors degree
    • 2 years credentialing experience preferred
    • 2 years experience in a medical practice business office role required