Credentialing Coordinator
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At a glance
Requirements
Credentials this posting asks for.
Job overview
Wellspan Health is hiring a Credentialing Coordinator. The Credentialing Coordinator maintains close communication with providers, practice managers, and the medical staff office to ensure timely initial credentialing, recredentialing, and reappointments across various entities, adhering to policies, conducting QA checks, and managing data updates while upholding confidentiality and service quality.
Key focus areas include Process initial provider enrollment with payers and credentialing applications, Create, assemble, and prepare application packets for providers and submit to payers, and Verify provider credentials through primary source verification.
Important skills include Data Entry, Computer Skills, and Organizational Skills. Preferred (not required): Cactus, CAQH, National Practitioner Data Bank, and Multi‑Tasking.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Job Identification 228343
Job Category Legal and Compliance
Job Schedule Full time
Job Shift Shift1 - Day
Locations 601 Memory Ln, York, PA, 17402, US
Assignment Category Not Applicable
FTE 1
Job Description
General Summary
Maintains close communication with providers, practice managers and the medical staff office to ensure timely initial credentialing, recredentialing and reappointments through the different entities, Credentials Committee and Board of Directors Meetings.
Responsibilities
Duties and Responsibilities
Essential Functions:
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Processes initial provider enrollment with payers, initial credentialing and recredentialing: • Creates, assembles and prepares application packet for providers to complete, reappointment applications for WellSpan Health entities and submits applications to payers. • Completes primary source verifying provider credentials per established policies and procedures. • Enters provider credentials and application requirements into Cactus, CAQH. • Initiates mandated queries, both federal and state, for all initial applicants and those due for recredentialing with the National Practitioner Data Bank. • Adheres to all policies and procedures regarding mandated queries and reporting mechanisms. • Maintains close communication with provider, practice managers, medical staff office, insurance reps, locum tenens agencies, office administrators to ensure timely credentialing through the different entities. • Reviews and conducts QA checks on the applications prior to medical director’s review. • Reattests provider information every 120 days in CAQH. • Runs reports and complete Medicare and Medicaid revalidations for WellSpan Medical Group (WSMG) & Hospital Based providers. • Maintains confidentiality of provider information.
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Data Management • Follows up, receives and documents confirmations on all initial enrollment status and changes for health plan providers with which WellSpan participates. • Runs weekly Credentialing Update reports to IS Department for billing system update. • Runs expiring provider credentials reports, notifies practices and updates Cactus accordingly. • Assists with helping resolve claim issues by contacting applicable provider reps.
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Change letters • Creates and submits letters to update payers, Cactus, CAQH, NPI and other stakeholders of any changes and terms to provider data per 25 payer requirements.
Common Expectations:
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Maintains established policies and procedures, objectives, quality assessment and safety standards.
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Maintains professional growth and development.
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Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Qualifications
Qualifications
Minimum Education:
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High School Diploma or GED Required
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Associates Degree Preferred
Work Experience:
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2 years Relevant experience. Required
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Hospital/physician office/insurance claims or credentialing experience. Preferred
Licenses:
- Certified Provider Credentialing Specialist Upon Hire Preferred
Knowledge, Skills, and Abilities:
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Ability to multi-task and work independently by prioritizing work load.
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High level of organizational skills.
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Proficiency in data entry.
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Ability to handle interruptions such as phone calls, emails and meetings.
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Excellent computer skills.
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Excellent communication/interpersonal skills.
Benefits Offered:
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Comprehensive health benefits
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Retirement savings plan
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Paid time off (PTO)
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Education assistance
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Financial education and support, including DailyPay
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Expanded Paid Parental Leave
For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org) (https://www.joinwellspan.org/benefits/)
WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.
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