Job Description

Job Title:                       Coordinator, Credentialing and Insurance Contracts

Reports To:                   Assistant Director of Revenue

Job Summary:                     Coordinates credentialing documentation of all licensed professional medical, dental, and behavioral health staff in a timely and accurate manner. Effectively communicates third party and internal credentialling and licensing information throughout the organization. Understands health insurance contractual arrangements with health center and all types of credentialling requirements and implements documentation of this within the organization. Coordinates health care licensing of providers and facilities within the organization.

                                                                                                                                                                                                                               

Qualifications and Requirements:

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

 

Credentialing:

  • Works directly with contracted third party credentiallng organizations to ensure our provider staff is up to date and compliant with all credentialling requirements.
  • Communicates and collaborates effectively with HR, Risk Management, CCHCI board, providers and other departments to initiate new provider credentialling, terminate departing staff and otherwise distribute timely credentialled status to the organization.
  • Understands and/or Performs Primary Source Verification of all staff required to be credentialed, if necessary.
  • Reviews information and communicates with insurance companies, etc. to ensure that all licenses, certifications, and credentials are accurate and current and do not lapse. The use of proprietary software (e.g. Modio) to track this will be mandatory.
  • Prepares any additional paperwork required for providers to practice and to receive payment from insurances, and other private and government agencies, as necessary.
  • Communicates with providers and licensed professional staff to ensure that all steps necessary to maintain current licensure are being taken.
  • Obtains signatures from providers as needed and double-checking attestation status as necessary.
  • Provides timely notifications for providers to renew their licensure prior to expiration.
  • Processes and submits all required documents as needed.

 

 

Insurance Contracts Management and Assistance:

  • Coordinates and directs incoming and outgoing provider contracts from various health care organizations.
  • Manages storage and organization of said contracts and amendments and uploads into and uses contracting software such as Modio, Compliatric and Parathon proprietary systems.
  • Familiar with Nextgen libraries and contract management and uploads documents.
  • Assists billing department in running reports from above software.
  • Uses information from contract management systems to assist in gathering information about improper payments and denials for provider services.
  • Uses above denial information to correct and rebill or re-task unpaid encounters as needed.
  • Maintains a list of current insurance website, portal and contact information and coordinates insurance rep visits with the Revenue Department
  • Maintains and keeps updated on current understanding of insurance payor and plan changing provider billing information.

 

Required Education, Experience, Certificates & Licenses:

  • High School Diploma or GED required.
  • One year of experience in credentialing and related experience in health care billing processes.
  • Any combination of experience and/or education that provides the necessary skills will be considered.

 

Preferred Education, Experience, Certificates & Licenses:

  • Associates degree in health care related field or business preferred.
  • Experience with health care PM software and or contracts management software systems preferred.

 

Other Required Skills:

  • Ability to comprehend and compose effective instructions, correspondence, and communications in English in both oral and written format.
  • Ability to perform basic math and arithmetic skills including addition, subtraction, multiplication, and division.
  • Experience and/or training in Microsoft Office suite such as Word, Outlook and Excel.

 

Physical Requirements:

  • Ability to occasionally exert enough force to move objects weighing up to 10 pounds.
  • Ability to continuously remain in a stationary position.
  • Ability to occasionally move about inside the workplace to access files, office machinery, etc.
  • Possesses hand-eye coordination and manual dexterity necessary to constantly operate computer, telephone, and other office machinery.
  • Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.
  • Ability to discern the nature of sounds at a normal spoken volume.

 


Other Required Knowledge, Skills, and Abilities:

  • Ability to add, subtract, multiply and divide in all measure, using whole numbers, common fractions and decimals.
  • Ability to compute rate, ratio and percent.
  • Ability to gather data in an organized fashion from varied sources.
  • Ability to perform variety of assignments requiring independent judgment.
  • Ability to deal with challenges involving one or more variables in routine situations.
  • Knowledge of billing, medical records, health plans, and community health centers preferred.
  • Knowledge of current credentialing requirements of payers and agencies.
  • Computer literacy required.
  • Knowledge of Electronic Health Records preferred.

 

Work Environment & Conditions:

  • Work environment is usually typical of an administrative office setting with no substantial exposure to adverse environmental conditions.