Credentialing Coordinator - Henrico, United States - Community Care Network Of Va

Description

Job Description

Job DescriptionAt Cenevia, we eliminate operational burdens so our healthcare delivery champions can focus on providing high-quality and cost-effective health outcomes. Since 1996, Cenevia has been a trusted support system, training partner and business process expert for health providers, including Federally Qualified Health Centers (FQHC), private practices, hospitals, managed care organizations, and provider networks.

Cenevia provides integrated, network-based services and programs to healthcare clients to help them run their businesses better so that they can focus on patient care. This includes the centralized practice management system, help desk, and support infrastructure that Cenevia established in 1999.

The Cenevia staff includes experienced health care professionals from the following areas:

• Quality Improvement
• Health Information Technology
• Revenue Cycle Management
• Health Plan Contracting
• Credentialing and Enrollment (NCQA-certified)

Summary/Objective:

This non-exempt position performs administrative duties requiring accuracy and attention to detail in the credentialing/recredentialing process. Maintains continuous contact with internal and external customers, including practitioners, administrators and support staff. Additionally, this position is responsible for communicating provider information to stated internal and external customers through established processes for privileging/credentialing/recredentialing.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Essential Functions:

Core duties and responsibilities include the following. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

• Manual Entry of Practitioner information into the credentialing data base in a timely manner
• Ability to read, extract and interpret information comparing such to established departmental policies. Maintains a computerized database of practitioner data for use in the credentialing & enrollment process
• Excellent verbal and written communication skills
• Self-motivated with the ability to complete projects independently within established timelines
• Ensures workload deadlines are being met in a consistent manner
• Must be flexible and willing to work extra hours during peak workloads and deadlines
• Ability to problem solve, make decisions and effectively communicate
• Ability to work productively within a team
• Prepares and provides reports, recredentialing applications, status reports, expired items reports and completed file reports to assure time frames are met and filing and scanning when necessary
• Accurately perform a variety of administrative duties such as: placing calls, processing facsimile verifications, scanning, sending written inquires, filing and copying.
• Pursue incomplete information in reference to provider health plan enrollment
• Ensures consistent & complete verification of practitioners credentialing/recredentialing and privileging
• Maintains a computerized database of practitioner data for use in the credentialing/recredentialing and privileging process
• Generates verification letters, and upon receipt of verification letters, logs the appropriate response in the Credentialing database
• Maintains detailed credentialing/recredentialing and privileging files in electronic format, including electronically received documents, and document each stage of credentialing/recredentialing and the privileging process thoroughly
• Ensures workload deadlines are being met in a consistent manner
• Prepares files and supporting data for Credentials Committee meeting if applicable
• Develops and maintains good working relationships with practitioners and support staff to obtain necessary and timely information to facilitate the provider enrollment/reenrollment process if applicable
• Works collaboratively with fellow team members to maintain department workflows, processes, policies and systems. Additionally, each team member is expected to cross-train on location and provider type / group or plan type requirements to assist one another in completing assigned duties as the enrollment cycle warrants
• Ability to independently resolve problems, make decisions, and negotiate issues as needed
• Tracking of provider credentialing/recredentialing and privileging applications timely for the closure of practitioner files
• Competence in displaying superior customer service skills

QUALIFICATIONS:

• High School diploma or GED required
• Preferred one (1) year experience in healthcare credentialing (i.e., healthcare facility, credentials verification organization, or Medical Staff Office)
• Preferred working knowledge of the health care and credentialing industry, regulatory agencies, and other national standards
• Able to work with minimal supervision and ability to work well in both individual and group environment
• Experience with Microsoft Word Office Suite

COMPETENCIES:

To perform the job successfully, an individual should demonstrate the following competencies:

• Adaptability -- Dealing effectively with change and acclimating /adjusting to a dynamic environment.
• Admin Compliance -- Adhering to appropriate SOP's [Standard Operating Procedures], guidelines, parameters, standards, policy, procedure, and/or protocols.
• Client Focus -- Anticipating, understanding, and fulfilling customer needs and expectations by providing excellent direct and indirect service.
• Communication -- Conveying and receiving information and ideas efficiently and effectively through a variety of organizational mediums.
• Problem Solving -- Using problem analysis skills to identify and define issues for resolution and choosing optimum courses of action.
• Productivity -- Ensuring efficiency requirements are met even in the face of time or resource restrictions.
• Skills -- Demonstrating sincere interpersonal sensitivity with regard to self's and others' comfort, feelings, worth, and well-being.
• Teamwork -- Working effectively as part of a team through the practices of subordination, support, and cooperation.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand and walk.

The employee must occasionally lift and/or move up to 10 pounds.

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

The noise level in the work environment is usually moderate.

Cenevia is an equal opportunity employer.

At Cenevia, we believe diversity brings strength and adaptability by drawing on a broad range of talents, experiences and perspectives, and affords an inclusive workplace and culture where all people, regardless of gender, race, ethnicity, sexual orientation, or background, feel a sense of belonging.

This position is remote, and employee must have suitable and secure technology to be eligible for consideration – e.g., secure Wi-Fi, telephone, dedicated workspace. Additionally, employee is required to participate and be seen in meetings via video conference as part of this role.