Credentialing Coordinator, RMF Revenue Cycle

DHR Health - US:TX:Edinburg - Days

Summary:

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

Works to promote and support the functions of RMF provider credentialing. Under the direction of the RMF Senior Director, is the primary person responsible for the coordination and credentialing of all Renaissance Foundation providers’ files, including the processing of new and established providers’ applications; as well as credentialing through the various required organizations obtaining all updated licenses and other required documents. Maintains data base and updates information in Cactus Credentialing software. Performs general office work related to credentialing and other RMF functions, including typing, preparation of confidential and special reports, sending emails, sending invoices and making phone calls as well as other assigned duties.

POSITION EDUCATION/ QUALIFICATIONS :

• Associate or bachelor’s degree preferred.

• Minimum two (2) years of physician credentialing experience, preferred.

• Experience with Cactus Credentialing Software, preferred.

• Billing experience in physician medical practice, preferred

• Two years in physician office or hospital environment, preferred.

• Knowledge of general office procedures, including but not limited to filing and recordkeeping.

• The position requires a broad knowledge of the health care environment and the credibility to work well with physicians and other health care professionals regarding their credentialing applications.

• Medical terminology knowledge desired.

• Excellent customer service and interpersonal s skills.

• Meet priority due dates, as defined

• Ability to multitask and manage several projects.

• Computer skills required with knowledge of Microsoft Office suite, with a focus on word and excel.

• Good written and verbal communication skills required.

• Bilingual-English/Spanish preferred.

JOB KNOWLEDGE/EXPERIENCE :

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices.

• Assists department with other duties and issues as necessary

• Provides excellent customer service when the opportunity arises.

• Must be well organized for prioritization of responsibilities.

• Must be able to handle stress relative to rush projects and meeting deadlines. Must be able to work under pressure in a highly a productive office.

• Must be able to cope with interruptions, varying personalities and some irregular hours.

• Must possess organizational and communication skills.

• Must possess willingness to improve.

Responsibilities:

POSITION RESPONSIBILITES:

• Is the primary person responsible for performing credentialing activities for Renaissance Foundation providers in accordance with established policies and procedures, to include but not limited to maintenance and verification of current Texas licensure, DEA, CAQH data, NPI data and malpractice insurance. .

• Responsible for navigating and completing work assigned on Medicare, Texas Medicaid, and various direct insurance payors contracts.

• Responsible for updating various databases used in credentialing.

• Responsible for the completion of provider credentialing before the first day of clinic.

• Responsible for managing the timeliness of re-credentialing and re-attestation deadlines

• Responsible for communicating with departments and team members regarding high priority items, as they arise.

• Assist when claims denied due to out of network and / or dispute of managed care provider effective dates or other information.

• Maintains and updates departments when managed care companies send notice of provider participation and effective dates.

• Maintains the Master Credentialing Workbook with timely clinic information of additions and changes in service location address.

• Work collaboratively with fellow team members.

• Responsible for maintaining an ongoing list of all payor agreements.

• Is responsible for maintaining up-to-date the physician and allied health provider master files and validating monthly with above information.

• Assures completeness of all providers’ credentialing files, including but not limited to corresponding with outside agencies regarding verification of information.

• Completes weekly updates of provider credentialing every Friday and validates its accuracy prior to distribution.

• Assists in overseeing and maintaining payor contracts

• Has complete oversight and maintenance of the Managed Care Contract, including but not limited to updating master list, providing Provider Disclosure, Military Discharge etc. and trouble-shooting problems and delays for physician members, as well as speaking to representative.

• Provides updates to the PHO credentialing department of all current providers Medicare and TMHP Medicaid provider effective dates

• Assists and coordinates with DHR Medial Staff provider applications

• Assist with working billing denials and works towards a resolution.

• Reviews new providers’ files for completeness and prepares and sends follow- up requests when needed.

• Maintains confidentiality of all credentialing files and other information handled in the DHR, RMF and PHO office.

• Identifies inconsistencies in providers’ files and performs corrective follow-up as necessary.

• Maintains system in monitoring providers’ information – including but not limited to rosters; runs special reports as requested and shares with Supervisor and Director regularly.

• Follows up on missing information and obtains appropriate approvals.

• Understands managed care environment and be familiar with operations of managed care organizations, especially provider contracting.

• Assists in responding promptly to provider concerns, questions and issues.

• Communicates with managed care plans, physician members’ staffs through accurate and neatly typed emails and reports. Proofreads to ensure accuracy.

• Maintains close communication with PHO credentialing and Medical Staff Office team members.

• Responsible for typing, faxing correspondence, reports etc. regarding credentialing and required by the Department.

• Completes all assignments timely and by the designated due date.

• Tracks progress and status of all assigned task

• All other assigned duties.

LINES OF RESPONSIBILITY :

(Chain-of-command)

1. Credentialing Manager 2. VP of RMF Revenue Cycle 3. Chief Ambulatory Officer

Other information:

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC :

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA) :

A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes : HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________

Transfer/Hire Date Effective: ________________________.