Position Title: Coordinator, Credentialing
Department: Payor Contracting

Purpose: Performs necessary activities to ensure practitioners are credentialed/ re-credentialed with participating insurance plans of GHS in compliance with regulatory standards and in accordance with policies and procedures. Supports integrity of providers participation status across GHS entities and communicates practitioner updates to the appropriate parties.  Maintains working knowledge of Medical Staff Bylaws, Rules, and Regulations, and policies. Builds and maintains positive relationships with managed care insurance/ payers, employed practitioners, and serves as a resource regarding insurance credentialing issues, concerns and inquiries. Provides assistance with policies and processes to support payer designation for centralized credentialing/ credentialing verification organization (CVO). Serves as a central point of contact for provider participation issues pertaining to enrollment for internal and external customers. When necessary, will perform other duties as assigned.

Report To: TPHSO Credentialing Manager

Supervisory Responsibility: Guidance: The job requires the provision of occasional guidance and training to others. The job does not have formal or official supervisory responsibilities.

Materials Responsibility: Very Limited. Work requires very limited responsibility for material resources.  Examples of resources could include personal work materials, supplies or equipment, or very small amounts of cash. The employee has a very limited or indirect amount of control over these resources. Although human error might require the repair or replacement of materials, usually the cost of correcting these errors is minor.  The variety and volume of resources is also very limited.  Problems associated with material resources are very uncomplicated.

Key Relationship: Co-workers/Health System Employees, Outside Agencies/Other Health Care Providers, General Public/Visitors/Volunteers, Physicians/Medical Office Staff, Students/Interns/Residents/Outside Instructors, Patients, Families, and Significant Others, Auditors/Review Agencies, Third Party Payors/Insurance Companies.

POSITION SPECIFICATION 

Education: 2 year college program or equivalent experience

Field Of Study: Business, or Health Care Studies

Special Training: Medical terminology, Excel spreadsheet proficiency, word processing (minimum of 60 wpm), strong computer skills

Training Preferred: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)

Experience: More than 1 year experience required.

Interpersonal Skills: Interaction is with a variety of people inside or outside the organization. Communications are of moderate difficulty and sensitivity. Contact with others may involve detailed & lengthy dialogues & exchanges of information. Requires a moderate amount of interpersonal skills. Interactions involve dealing with moderately complicated problem situations or stressful encounters.

Physical Demands: Low Intensity: Work requires a light or low amount of physical exertion. The job requirements for manual dexterity or physical manipulation are limited.  The need for physical stamina and endurance is of minimal or low significance.  The degree of physical strain produced on the job is somewhat taxing, but does not usually produce fatigue and require periods of rest.  Freedom of movement exists, and the job does not confine the employee to a prescribed body posture.  Body movement usually involves sitting and intermittent walking.  The position exceeds these low intensity demands rarely, 10% of the time or less.

Working Conditions: There is very limited exposure to adverse environmental conditions. Some undesirable or unpleasant environmental characteristics may occur but the physical environment is generally safe and there is minimal health risk.  No safety equipment or unusual precautions are required.  The amount of time the employee may experience these minor adverse conditions would be limited to 10% or less of the work day.

Possible Exposure to Blood Borne Pathogens: None

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.