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    Provider Enrollment and Credentialing Coordinator - New York, United States - Columbia University

    Columbia University
    Columbia University New York, United States

    1 week ago

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    Description
    • Job Type: Officer of Administration
    • Bargaining Unit:
    • Regular/Temporary: Regular
    • End Date if Temporary:
    • Hours Per Week: 35
    • Standard Work Schedule: 9-5 pm
    • Building: Fort Lee
    • Salary Range: $62,000- $67,000
    The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting.

    Position Summary

    The Provider Enrollment & Credentialing Coordinator performs provider enrollment and credentialing functions to support the ColumbiaDoctors Credentialing Program, data maintenance activities, and payer enrollments.

    Responsibilities

    Technical

    • Work closely with key internal and external stakeholders to complete comprehensive audits of credentialing, demographic, and participation data, performing timely corrections as deficiencies are identified.
    • Receive, review, analyze, and process a high volume of credentialing and enrollment requests for delegated, non-delegated, government, and third-party payers and vendors.
    • Provide timely feedback on data/documents utilizing standard checklists and reports. Identify and escalate critical incomplete items and issues, highlighting important deadlines.
    • Maintain current and valid credentials, documents, forms and applications in collaboration with internal and external stakeholders, in accordance with Standard Operating Procedures.
    • Perform data entry and document imports to maintain provider profiles and track application/credentialing/enrollment status.
    • Conduct timely and consistent follow-up, escalating if no response, insufficient feedback, or unacceptable response.
    • Log, troubleshoot and track enrollment, credentialing, contractual, fee schedule, and demographic payer and provider issues. Clearly identify action needed and responsible party(s) and communicate follow-up in a consistent manner.
    • Participate in departmental and payer meetings with internal and external stakeholders, documenting discussions and follow-up items.
    • Conduct proactive and timely internal and external verification initiatives and roster audits.
    • Verify credentials by searching third-party databases, determining the validity of data and documents received, and accepting/rejecting information accordingly.
    • Assess and reprioritize work in accordance with shifting priorities and backlog in conjunction with the supervisor.
    • Assist with credentialing, enrollment, and operational projects and reporting as needed.
    • Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures.
    • Establish and maintain positive relationships with providers, practices, and payers.
    • Works collaboratively with fellow team members to regularly evaluate the effectiveness of department Standard Operating Procedures and workflows and identify gaps. Provides feedback and recommendations to the supervisor for improvements. Implements approved changes.

    Compliance and Other

    • Perform related duties as assigned within the scope of practice.
    • Represents PEG on committees, task forces, and work groups as assigned.
    • Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.
    • Perform other related duties and responsibilities as assigned/requested.

    Minimum Qualifications

    • Bachelor's degree or equivalent in education and experience.
    • Must demonstrate strong analytical and problem-solving skills with attention to detail and accuracy.
    • Strong time management skills including planning, organization, multi-tasking, and ability to prioritize required.
    • Must demonstrate effective communication skills both verbally and written.
    • Demonstrated proficiency in Microsoft Office (Word & Excel) or similar software.
    • Must be a motivated individual with a positive and exceptional work ethic.
    • Must successfully complete systems training requirements.
    • Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
    • Must successfully pass systems training requirements.

    Preferred Qualifications

    • Specialized knowledge of managed care credentialing/enrollment is preferred.
    • Prior experience at an academic medical center or health insurance plan is preferred.
    • Prior experience with IntelliCred, Cactus or a similar credentialing system is preferred.
    • Intermediate knowledge of Microsoft Excel (e.g. vlookup, pivot tables, etc.) or similar software is preferred.

    Other Requirements

    Patient Facing Competencies

    Minimum Proficiency Level

    Accountability & Self-Management

    Level 2 - Basic

    Adaptability to Change & Learning Agility

    Level 2 - Basic

    Communication

    Level 2 - Basic

    Customer Service & Patient-Centered

    Level 3 - Intermediate

    Emotional Intelligence

    Level 2 - Basic

    Problem Solving & Decision Making

    Level 3 - Intermediate

    Productivity & Time Management

    Level 3 - Intermediate

    Teamwork & Collaboration

    Level 2 - Basic

    Quality, Patient & Workplace Safety

    Level 2 - Basic

    Leadership Competencies

    Minimum Proficiency Level

    Business Acumen & Vision Driver

    Performance Management

    Level 1 - Introductory

    Innovation & Organizational Development

    Equal Opportunity Employer / Disability / Veteran

    Columbia University is committed to the hiring of qualified local residents.

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