Credentialing Coordinator, Lead

Position Summary: Responsible for maintaining provider credentials and the timely and accurate filing of the credentials for insurance and hospital contracting. Provides peer leadership to the Credentialing Coordinator team.

Responsibilities/Accountabilities:

• Coordinates and leads the credentialing team in all physician and resource credentialing with all hospitals, medical boards, and credentialing vendor.
• Demonstrates strong communication skills with hospital medical staff offices, insurance payers and physicians. Strong attention to details skills with a focus to meet targets for hospital credentialing meeting deadlines.
• Communicates with providers to advise of renewal of licensure and certification updates.
• Maintain PECOS and payer websites for physicians and advance practice providers.
• Provides weekly and ongoing credentialing update communications to operations regarding changes to the credentialing status of new providers.
• Performs other administrative tasks at the request of management as related to credentialing and board certification documentation.
• Provides guidance, education and workflow efficiencies for all aspects of credentialing, enrolling and privileging of Orthopedic One billable providers.
• Communicates with payer provider representatives to ensure group contracts and fee schedules are maintained and kept up to date.
• Assists with payer contract negotiations and ensures claims are adjudicated per our payer contracts.
  
  

Customer Service and Communications:

• Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.
• Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.
• Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.
  
  

Teamwork:

• Works cooperatively with coworkers, providers, and management.
• Shares knowledge and insights with co-workers in a constructive manner.
• Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
• Addresses conflicts with person directly before involving manager or uninvolved peers.
• Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.
  
  

Policies and Procedures:

• Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
• Provides assistance and support to leadership in implementing policies and procedures as necessary.
• Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.
  
  

Education, Experience, and Certification/Licensure Required: High School Diploma or equivalent required. Candidates must have a minimum of five years of work experience with healthcare provider credentialing. Knowledge of revenue cycle functions and healthcare experience required.

Location: Orthopedic One

• Patient Accounts Schedule: Regular Full Time, Day Shift