GENERAL SUMMARY OF DUTIES:
The Credentialing Coordinator is responsible for ensuring that each medical office contracted with Practice Health and Colorado Care Partners (CCCP) is up to date on their payer contracts, and that that they have access to their fee schedules and an understanding of those fee schedules. This position obtains the credentialing packets from the offices and manages the credentialing files as well as answers any customer service questions and complaints. As Credentialing Coordinator, this position ensures that all physician files, both electronic and paper, are up to date. This position acts as a liaison between the health plans and practice (or provider) with the ultimate goal of adding (or removing) each individual provider and corresponding Tax Identification Number or (TIN) to the Practice Health group, health plan contracts. Responsible for provider services functions including outreach, provider credentialing and the configuration of contracts and provider support. This position is an outward face of its clients such as Practice Health and CCP and works collaboratively with all Physician Members and their office staff. The Credentialing Coordinator will meet with all assigned practices at least once per year either telephonically or in person to ensure all customer service needs are being met.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
- Gather documents required to initiate credentialing and configuration of a member’s health plan contracts.
- Serve as a liaison between member practices and payers for problem resolution, contract disputes, reimbursement issues, credentialing etc.
- “Update” health plans with additions, demographic changes and terminations applicable to Practice Health contracts.
- Follow up with health plans monthly to request effective dates and supply additional documentation to support loading to Practice Health contracts.
- Manage CAQH (Council for Affordable Quality Health Care) profiles for approximately 300 providers; re-attest every 90 days, upload renewed documents and communicate with practices regarding demographic updates and other applicable payer credentialing sites.
- Facilitate physician fee schedule configuration through the messenger model process on behalf of individual member practices
- Answer customer service call about credentialing, payer issues etc.
- Initiate Credentialing Fee invoicing and collection of membership dues through QuickBooks
- Payor Relations and Physician Advocacy with claims, demographic or credentialing disputes
- Coordinates Roster changes and maintains email distribution lists to all member physicians, office staff and HealthONE personnel within Sales Force Marketing or other marketing and communications tools.
- Builds strong interpersonal working relationships with practice staff, physicians and payer representatives; utilize problem solving skills to resolve issues
- Other duties as assigned
- Always be ready for unexpected projects and changes
- Minimum three (3) years’ experience with credentialing, contracting, or network development in a health insurance environment required
- CPCS certified preferred
- College degree in business, communications or health care administration preferred
- Must have experience in customer service, medical practice management and physician credentialing
- Excellent written, verbal, interpersonal communications skills
- Proficient in Microsoft Office programs (i.e., Word, Outlook, Power Point & Excel (VLOOKUP)).
- Must be highly organized'
Job Types: Full-time, Contract
Pay: $22.00 - $26.00 per hour
- 8 hour shift
- Monday to Friday
- High school or equivalent (Preferred)
- Microsoft Office: 3 years (Preferred)
- Microsoft Word: 3 years (Preferred)
Work Location: One location
4900 South Monaco Street, Denver, CO 80111
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