Credentialing Coordinator - Day

Company: WellSpan York Hospital
Location: Chambersburg
Posted on: March 19, 2023

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