Credentialing Coordinator - Per Diem

Job Profile Summary

This role focuses on providing administrative and business support to the organization in order to achieve operational goals. In addition, this role focuses on performing the following Credentialing duties: Processes provider applications and re-applications including initial mailing, review, and loading. Maintains provider profiling system and communicates with providers by phone and mail regarding credentialing status and information. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.

Job Overview

This position provides support for the Provider Enrollment functions by coordinating the appointment and reappointment process for the physician group. Coordinates and maintains computer database of provider information. Communicates and works with insurance representatives and provider relation administrators.

Job Description

Minimum Qualifications:

1. High School Diploma or equivalent.

2. One (1) year of related experience.

Preferred Qualifications:

1. Three (3) years of provider enrollment, prior authorization, billing, or similar experience.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Processes provider enrollment packets for completion to send out to insurance companies in a timely manner.

2. Prepares agenda and attends meeting as directed, takes and transcribes minutes.

3. Prepares questionnaire packets for distribution to physicians.

4. Maintains logging systems to ensure that all packets are returned.

5. Upon return of packets, reviews data for completeness.

6. Follows up to obtain missing information as needed.

7. Types and distributes reports, statistical data, letters, and other documents.

8. Enrolls physicians in the appropriate reimbursement programs and ensures that the billing office is able to process their fees and collect payment from those programs on a timely basis.

9. Coordinates with the Hospital Managed Care Office the application for other HMO with which the Hospital and physicians are contracted.

10. Works in conjunction with the Hospital Managed Care office, Hospital Finance Department and Tufts MC P.O. systems to maintain a consistent and accurate information regarding physician billing and license numbers.

11. Collects, verifies and submits to P.O. and Hospital systems all pertinent information for the purpose of billing for physician license numbers; correct spelling of physician names and appropriate billing areas and location.

12. Conducts interviews with new physicians, explaining the enrollment process, asking the necessary information and obtaining signatures.

13. Answers questions from the Departments, Accounting, Patient Accounts and physicians regarding provider information.

14. Corresponds and contacts via telephone third-party provider relations representative to update enrollment requirements.

15. Manages the physician information database in physician profile system.

16. Receives and responds to requests for lists and labels from other departments.

17. Maintains staff physician applications and files on an ongoing basis.

18. Files and retrieves documents.

19. Inputs information and conducts audits of the information to ensure its completeness and accuracy.

Physical Requirements:

1. This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending/descending stairs, and operating office equipment.

2. Frequently required to speak, hear, communicate, and exchange information.

3. Ability to see and read computer displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.

4. Requires manual dexterity using fine hand manipulation to operate computer keyboard.

Skills & Abilities:

1. Ability to work independently and prioritize responsibilities.

2. Knowledge of Word processing and database (or spreadsheet).

3. Ability to effectively interact with outside agencies on behalf of the hospital.

4. Ability to work with highly confidential and sensitive information.