Credentialing Coordinator - Day
Company: WellSpan York Hospital
Location: Chambersburg
Posted on: March 19, 2023
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Job Description:
Schedule & Location: Full-Time: 80 hours, biweekly
Monday-Friday: 8am-5pm Remote work opportunity Job Description:
Under general supervision, maintains close communication with
providers, practice managers and the medical staff office to ensure
timely initial credentialing, recredentialing and reappointments
through the different entities, Credentials Committee and Board of
Directors Meetings. Duties and Responsibilities Processes initial
provider enrollment with payers, initial credentialing and
recredentialing: Creates, assembles and prepares application packet
for providers to complete, reappointment applications for WellSpan
Health entities and submits applications to payers. Completes
primary source verifying provider credentials per established
policies and procedures. Enters provider credentials and
application requirements into Cactus, CAQH. Initiates mandated
queries, both federal and state, for all initial applicants and
those due for recredentialing with the National Practitioner Data
Bank. Adheres to all policies and procedures regarding mandated
queries and reporting mechanisms. Maintains close communication
with provider, practice managers, medical staff office, insurance
reps, locum tenens agencies, office administrators to ensure timely
credentialing through the different entities. Reviews and conducts
QA checks on the applications prior to medical director's review.
Reattests provider information every 120 days in CAQH. Runs reports
and complete Medicare and Medicaid revalidations for WellSpan
Medical Group (WSMG) & Hospital Based providers. Maintains
confidentiality of provider information. Data Management Follows
up, receives and documents confirmations on all initial enrollment
status and changes for health plan providers with which WellSpan
participates. Runs weekly Credentialing Update reports to IS
Department for billing system update. Runs expiring provider
credentials reports, notifies practices and updates Cactus
accordingly. Assists with helping resolve claim issues by
contacting applicable provider reps. Change letters Creates and
submits letters to update payers, Cactus, CAQH, NPI and other
stakeholders of any changes and terms to provider data per 25 payer
requirements. Qualifications Minimum Experience: 2 - 3 years
Minimum Education: High School or G.E.D. Preferred Education:
Associate's Degree Preferred Field Of Expertise: Hospital/physician
office/insurance claims; credentialing experience Preferred
Certification: National Association of Medical Staff Services
(NAMSS) Certification as a Certified Provider Credentialing
Specialist (CPCS) Physical Demands: Mostly sedentary work
Occasional prolonged standing/walking Skills: Ability to multitask,
work independently by prioritizing work load, high level of
organizational skills, proficiency in data entry, ability to handle
interruptions such as phone calls, emails and meetings. Excellent
computer skills; excellent communication/interpersonal skills.
#remote
Keywords: WellSpan York Hospital, Germantown , Credentialing Coordinator - Day, Other , Chambersburg, Maryland
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