Position Purpose:
Responsible for the efficient administration of credentialing/re-credentialing for large multispecialty medical group and multiple hospital facilities. Coordinates the application and renewal of insurance credentialing and enrollment for multiple third-party payers. Maintains a variety of databases to support the credentialing and enrollment functions; acts as a liaison for providers, operations, revenue site operations, and professional billing for credentialing and enrollment processes. Provides dedicated support to the professional coding and billing teams.This is a full-time on-site position.What you will do:
1. Coordinates the third-party payor credentialing and re-credentialing processes for Medical Group Providers, including problem investigation and resolution.
2. Initiates the process to gather necessary documents to ensure efficient credentialing including provider's CV, state licensure, DEA, Board of Pharmacy and Proof of Malpractice, etc.
3. Coordinates the facility privileging and re-privileging processes for Medical Group Providers, including but not limited to: a. facilitates information collection, b. completes application forms, c. coordinates submission of applications, and d. supports necessary follow-up, problem investigation and resolution.
4. Facilitates malpractice application and renewal processes for all employed providers, including annual updates to payers and healthcare facilities.
5. Maintains files, database, and hard copy of each provider’s application.
6. Maintains and updates payer rosters.
7. Utilizes knowledge of payer contracts and reimbursement.
8. Works closely with leadership and various departments to maintain on-going communication regarding process status.
9. Builds working relationships with and conducts on-going communication with carrier representatives, facility Medical Staff representatives, providers, Practice Leaders, and Administration.
10. Provides real-time communication updates regarding provider credentialing status and/or payer requirements to appropriate Professional Billing representatives and Operational leaders, including managers, directors, and other administrative leaders. Once provider number is received, communicates with Clinical Informatics Department. Confirms provider number is entered into practice management system timely and accurately.
11. Coordinates the National Provider Identification application process for all new hire providers.
12. Performs CAQH updates and maintenance.
13. Sets up and maintains electronic provider credentialing files.
What you will need:
Education: Must be a high school graduate or have GED equivalent.
Experience: Hospital or Clinical experience preferred
Special Qualifications: Computer skills required.
Position Highlights and Benefits:
Day 1 benefits, no waiting period! Comprehensive benefit packages available including medical, dental, vision, paid time off and 403BColleague Referral Program to earn cash and prizesTuition Reimbursement and Student Loan Forgiveness OptionsUnlimited career growth opportunitiesMinistry/Facility Information:
St Mary’s Health Care System is proud to be a part of Trinity Health, one of the nations largest Catholic Healthcare Organizations.
St Mary’s Health Care System includes three hospitals, numerous physician practices, our region's first medical residency program, a retirement community, extensive outpatient services, and much more.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.