Midwestern University Credentialing Coordinator in Downers Grove, Illinois
This position credentials and facilitates health plan enrollment of Medical Staff and qualified advanced practitioners for Midwestern University Clinics.
*Essential Duties and Responsibilities *
- Prepares and reviews provider files for appropriate documentation required for the credentialing process.
- Communicates as needed with outsourced vendors and internal staff to maintain a detailed and compliant provider file credentialing system.
- Works with credentialing organization to complete initial credentialing for multiple providers with multiple healthcare insurers, maintain existing providers’ participation in healthcare plans, and coordinate receipt of primary source verification applications/documents. Communicates information to Clinics and Business offices
- Create and maintain credentialing database to track all applications, expirables, re-credentialing requirements
- Ensures accurate database content on current status of license registration, board certifications, and other types of credentials that are time sensitive. Follow up with applicable practitioners to update documents
- Develops and maintains internal Payer Provider grids, with current healthcare insurers’ information, in order to communicate updates on new/existing providers. Grids are shared with Medical Director, Clinic Deans, Patient Accounts Management, and clinic staff
- Registers with health plans web portals; maintain and update password access. Communicate updates to Patient Accounts dept. and providers
- Resolves credentialing issues with insurance companies
- Assists in maintaining central credentialing repository database (CAQH)
- Assists with gathering documents for payer audit requests
- Responds to payer requests for contract updates, W-9 copies
- Gathers information in response to patient and insurance inquiries
- Assist billing dept. in appeal preparation as it relates to payer issues
- Update Patient Accounts staff on payer changes
- Annually reviews Medicare providers, employees, managers, responsible for administering Medicare benefits, to ensure non-exclusion from Federal Health Care programs
- Assists in reviewing approval for hardship applications and maintains hardship application database
- Other duties may be assigned
S*upervisory Responsibilities *
No supervisory responsibilities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
*Education and/or Experience *
High school diploma or GED required. A minimum of 1 year credentialing experience with a minimum of 2 years accounts receivable experience in a specialty or medical business office required. Knowledge of ICD-9, CPT, HCPCS and Medical terminology. Experience with Medicare, Medicaid, Third party payers is also required. Excellent interpersonal skills, customer service, and verbal/written communication are required. Strong analytical thinking and problem solving skills are a must. Ability to perform detailed work with a high level of accuracy, strong organizational and time management skills required. Prefer Certified Professional Credentialing Specialist (CPCS) certification, or actively working toward meeting CPCS eligibility requirements.
*Computer Skills *
Computer proficiency in MS Office (Word, Excel, Outlook). Knowledge of clinics practice management systems and credentialing softwares.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to talk, hear, stand, walk, reach with hands and arms, use hands to handle and feel. The employee must occasionally lift and /or move up to 25 pounds.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
Midwestern University is an Equal Opportunity/Affirmative Action employer that does not discriminate against an employee or applicant based upon race, color, religion, gender, national origin, disability, or veterans status, in accord with 41 C.F.R. 60-1.4(a), 250.5(a), 300.5(a) and 741.5(a). We maintain a drug-free workplace and perform pre-employment substance abuse testing.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
High School or better
2 years:Accounts receivable experience in a specialty or medical business office
1 year:Credentialing experience
Posted: April 16, 2016