Dignity Health
Job Summary and Responsibilities
Job Summary:
The Credentials Coordinator is responsible for coordinating the credentialing, re-credentialing and payer enrollment process for Barrow Neurological Institute and contracted providers in accordance with the Health Plan's Delegated Credentialing Agreements, Physician Billing Services policies and procedures, industry best-practices, and regulatory requirements. Responsible for the daily credentialing operations, including resolution of non-responsive providers, and working with various clinic managers and the hospital medical staff office to ensure successful and timely completion of the delegated credentialing and re-credentialing process.
Essential Function:
Maintains up-to-date physician database of all applications, enrollment status, demographics, medical licenses, drug enforcement administration certificates, professional liability insurance, etc.
Responsible for the accuracy and integrity of data entered into the credentialing database system.
Assist in designing/compiling other data supporting various statistics utilized internally to monitor operations.
Responsible for continuous collection of information required to comply with delegated agreements and credentialing policies.
Conducts credentialing database training for new hires, and refresher training for existing staff. Provides input for training materials and job aids.
Reviews applications and other data sources for accuracy and completeness prior to submitting to Health Plan.
Acts as liaison with Health Plan representatives regarding individual credentialing applications; audits; provider load confirmation; fee schedule load issues; and addressing potential corrective action plans and monitoring for a successful resolution.
Maintains relationships with office personnel, Legal, Regulatory and Health Plan's Provider Relations department to provide and/or obtain documentation pertinent to timely and accurate completion of the delegated credentialing process.
Job Requirements
Minimum
High School Diploma/GED.
Three (3) years experience in a Health Care Plan Credentialing/Provider Relations and/or auditing setting, or Health Care Enrollment.
Preferred
Bachelors degree preferred
Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) Certification preferred.
Knowledge, Skills and Training:
Proficient with CACTUS Software, or similar credentialing system Intermediate Microsoft programs skills (MS Word, Excel, Power Point).
Knowledge of NCQA standards and Joint Commission standards.
Knowledge of commonly-used concepts, practices, and procedures used in health care and physician credentialing.
Where You'll Work
Hello humankindness (https://hellohumankindness.org/)
Located conveniently in the heart of Phoenix, Arizona, (http://phoenix.gov/visitors/index.html) St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a wide range of health, social and support services. Founded in 1895 by the Sisters of Mercy, St. Joseph's was the first hospital in the Phoenix area. More than 125 years later, St. Joseph's remains dedicated to its mission of caring for the poor and underserved.
We are extremely proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow Neurological Institute (https://www.barrowneuro.org/) , Norton Thoracic Institute (https://www.dignityhealth.org/arizona/norton-thoracic-institute) , Cancer Center at St. Joseph's (https://www.dignityhealth.org/arizona/locations/stjosephs/services/university-of-arizona-cancer-center) , Ivy Brain Tumor Center (https://www.ivybraintumorcenter.org/) , and St. Joseph's Level I Trauma Center (https://www.supportstjosephs.org/traumacenter) (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics, neuro-rehabilitation, orthopedics, and other medical services. St. Joseph's is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day, approximately 20 percent of the hospital's patients have traveled from outside of Arizona and the United States to seek treatment at St. Joseph's.
U.S News & World Report
routinely ranks St. Joseph's among the top hospitals in the United States for neurology and neurosurgery. In addition, St. Joseph's boasts the Creighton University School of Medicine at St. Joseph's, and a strategic alliance with Phoenix Children's Hospital.
St. Joseph's is consistently named an outstanding place to work and one of Arizona's healthiest employers. Come grow your career with one of Arizona's Most Admired Companies (http://www.bestcompaniesaz.com/) . Look for us on Facebook (http://www.facebook.com/DignityHealthStJosephsHospitalMedicalCenter) and follow us on Twitter (https://twitter.com/DignityHealthAZ) .
Pay Range
$24.33 - $36.19 /hour
We are an equal opportunity/affirmative action employer.
Job Summary:
The Credentials Coordinator is responsible for coordinating the credentialing, re-credentialing and payer enrollment process for Barrow Neurological Institute and contracted providers in accordance with the Health Plan's Delegated Credentialing Agreements, Physician Billing Services policies and procedures, industry best-practices, and regulatory requirements. Responsible for the daily credentialing operations, including resolution of non-responsive providers, and working with various clinic managers and the hospital medical staff office to ensure successful and timely completion of the delegated credentialing and re-credentialing process.
Essential Function:
Maintains up-to-date physician database of all applications, enrollment status, demographics, medical licenses, drug enforcement administration certificates, professional liability insurance, etc.
Responsible for the accuracy and integrity of data entered into the credentialing database system.
Assist in designing/compiling other data supporting various statistics utilized internally to monitor operations.
Responsible for continuous collection of information required to comply with delegated agreements and credentialing policies.
Conducts credentialing database training for new hires, and refresher training for existing staff. Provides input for training materials and job aids.
Reviews applications and other data sources for accuracy and completeness prior to submitting to Health Plan.
Acts as liaison with Health Plan representatives regarding individual credentialing applications; audits; provider load confirmation; fee schedule load issues; and addressing potential corrective action plans and monitoring for a successful resolution.
Maintains relationships with office personnel, Legal, Regulatory and Health Plan's Provider Relations department to provide and/or obtain documentation pertinent to timely and accurate completion of the delegated credentialing process.
Job Requirements
Minimum
High School Diploma/GED.
Three (3) years experience in a Health Care Plan Credentialing/Provider Relations and/or auditing setting, or Health Care Enrollment.
Preferred
Bachelors degree preferred
Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) Certification preferred.
Knowledge, Skills and Training:
Proficient with CACTUS Software, or similar credentialing system Intermediate Microsoft programs skills (MS Word, Excel, Power Point).
Knowledge of NCQA standards and Joint Commission standards.
Knowledge of commonly-used concepts, practices, and procedures used in health care and physician credentialing.
Where You'll Work
Hello humankindness (https://hellohumankindness.org/)
Located conveniently in the heart of Phoenix, Arizona, (http://phoenix.gov/visitors/index.html) St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a wide range of health, social and support services. Founded in 1895 by the Sisters of Mercy, St. Joseph's was the first hospital in the Phoenix area. More than 125 years later, St. Joseph's remains dedicated to its mission of caring for the poor and underserved.
We are extremely proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow Neurological Institute (https://www.barrowneuro.org/) , Norton Thoracic Institute (https://www.dignityhealth.org/arizona/norton-thoracic-institute) , Cancer Center at St. Joseph's (https://www.dignityhealth.org/arizona/locations/stjosephs/services/university-of-arizona-cancer-center) , Ivy Brain Tumor Center (https://www.ivybraintumorcenter.org/) , and St. Joseph's Level I Trauma Center (https://www.supportstjosephs.org/traumacenter) (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics, neuro-rehabilitation, orthopedics, and other medical services. St. Joseph's is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day, approximately 20 percent of the hospital's patients have traveled from outside of Arizona and the United States to seek treatment at St. Joseph's.
U.S News & World Report
routinely ranks St. Joseph's among the top hospitals in the United States for neurology and neurosurgery. In addition, St. Joseph's boasts the Creighton University School of Medicine at St. Joseph's, and a strategic alliance with Phoenix Children's Hospital.
St. Joseph's is consistently named an outstanding place to work and one of Arizona's healthiest employers. Come grow your career with one of Arizona's Most Admired Companies (http://www.bestcompaniesaz.com/) . Look for us on Facebook (http://www.facebook.com/DignityHealthStJosephsHospitalMedicalCenter) and follow us on Twitter (https://twitter.com/DignityHealthAZ) .
Pay Range
$24.33 - $36.19 /hour
We are an equal opportunity/affirmative action employer.