1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
2. Coordinates the third-party payor credentialing and re-credentialing processes for Medical Group Providers, including problem investigation and resolution.
3. 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.
4. 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.
5. Facilitates malpractice application and renewal processes for all employed providers, including annual updates to payers and healthcare facilities.
6. Maintains files, database, and hard copy of each provider’s application.
7. Maintains and updates payer rosters.
8. Utilizes knowledge of payer contracts and reimbursement.
9. Works closely with leadership and various departments to maintain on-going communication regarding process status.
10. Builds working relationships with and conducts on-going communication with carrier representatives, facility Medical Staff representatives, providers, Practice Leaders, and Administration.
11. 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.
12. Coordinates the National Provider Identification application process for all new hire providers.
13. Performs CAQH updates and maintenance.
14. Sets up and maintains electronic provider credentialing files.
15. Manages provider and other various databases; performs data entry and assists in managing and maintaining the provider database.
16. Provides dedicated support to the Professional Billing Department.
17. Other duties as needed and assigned by the manager
18. Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
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.