Managed Care Credentialing Coordinator - Rapid City
1 day ago
Job description
Current Employees
If you are a current Monument Health employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.
Rapid City, SD USA
Department
RCH Medical Staff Services
Scheduled Weekly Hours
40
Starting Pay Rate Range
$ $25.94
(Determined by the knowledge, skills, and experience of the applicant.)
Job Summary
This position is responsible for auditing credentials verifications compliant with NCQA Accreditation standards then directly responsible for enrollment of organizational facilities, service locations, professional groups, physicians, practitioners, and other billing providers with payers where is required in order for the organization to receive payment for services.
Managed Care Credentialing and Enrollment Specialists are accountable for maintaining and disseminating accurate plan participation status to operational and billing internal departments to maximize collections in the revenue cycle management process.
Function as subject matter expert for payer credentialing and enrollment representatives to ensure health system providers are fully credentialed and loaded as participating providers with all applicable government and commercial payers.
Monument Health offers competitive wages and benefits on qualifying positions.Some of those benefits can include:
Supportive work culture
Medical, Vision and Dental Coverage
Retirement Plans, Health Savings Account, and Flexible Spending Account
Instant pay is available for qualifying positions
Paid Time Off Accrual Bank
Opportunities for growth and advancement
Tuition assistance/reimbursement
Excellent pay differentials on qualifying positions
Flexible scheduling
Job Description
Essential Functions:
Directly responsible for oversight and collection of accurate credentialing of organizational providers, facilities and ancillary services.
Oversight and collection of documentation necessary for payer enrollment of complex hospital groups and services compliant with hospital system policies and accreditation sources such as NCQA, CMS and others.
Will perform primary source verification using pre-approved sources consistent with hospital system credentialing policies as needed to support credentialing and enrollment functionsEnsure compliance with applicable regulatory requirements, accreditation standards, payer policies, and governing documents.
Obtain application signatures from the authorized signatory and provide all required supporting documentation. Submit applications and follow up diligently to ensure timely processing. Respond to deficiency notifications in a timely manner. Follow up diligently on provider addition requests and communicate provider changes, corrections, and terminations. Continuously monitor enrollment process for improvements. Collaborate with Legal and Accreditation to ensure regulatory and compliance requirements are met.
Responsible for delegated credentialing policy interpretation and compliance. Responsible for annual payor credentialing file audits. Oversees delegated credentialing roster submission and tracking. Work with delegated payer contacts to address concerns within the delegation process while cultivating relationship with delegated payers.
Works collaboratively with Credentialing Manager and Coordinator to promote data integrity and to optimize effectiveness of the Credentialing database, ensuring consistency in data entry rules.
Supports the implementation of new database modules applicable to Managed Care. Implementation includes data migration and validation, as well as data mapping to demographic reports, participation reports, and training.Functions as the subject matter expert for the credentialing department. Provides training related to credentialing and payer enrollment that enhances knowledge, develop skills and enrich the team.
Excellent interpersonal skills and ability to work efficiently with internal and external customers. Maintain positive working relationships with payer representatives, providers, and all Monument Health internal departments.
All other duties as assigned.
Required
Additional Requirements
Education - High School Diploma/GED Equivalent in General Studies
Preferred
Education - Associates degree in Healthcare
Certification - Certified Provider Credentialing Specialist (CPCS) - Accredited University or accredited training professionals
Experience - 2+ years of Healthcare Experience; 2+ years Management Experience; 2+ years Credentialing Experience; 2+ years Billing/Collections Experience; 2+ years Medical Terminology Experience
Physical Requirements
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.
Job Category
Business Administration
Job Family
Business Services
Shift
Requires the ability to work assigned schedules and hours as determined by the department
Employee Type
Regular
10 Monument Health Rapid City Hospital, Inc.
Make a difference. Every day.
Monument Health is an Equal Opportunity/Affirmative Action employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.
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