Professional Physical Therapy
Reporting directly to the Credentialing Manager, the Credentialing Coordinator assists in ensuring applicable providers are licensed and certified as mandated by state and federal regulations, and that notification to payers is timely and complete. Responsible for monitoring and maintaining the process for credentialing and re‑credentialing providers. Works with team members in the RCO to share pertinent information regarding providers credentialing status and communicates effectively. Collaborates with team members and uses applicable RCO tools and systems to ensure credentialing statuses remain current and accurate.
Hourly Rate:
$24.04 - $25.90 (pay is commensurate with level of experience)
Essential Functions
Prepares credentialing files for completion and distributes them to new providers
Coordinates and monitors the review and analysis of clinicians' re‑credentialing and accompanying documents, ensuring provider eligibility
Works with the RCO and Credentialing team on various credentialing functions, regardless of payer. Follows determined processes to monitor and maintain systematic and timely credentialing
Follows departmental standards and policies and procedures to ensure the accuracy of credentialing data in Professional Physical Therapy EMR database
Leads, coordinates, monitors the review and analysis of practitioner applications, and accompanying documents, ensure applicant eligibility
Maintains fee schedule documentation pertaining to rates, rate escalators, schedule of payor contracts terms & payer policy
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up
Prepares credentialing files for completion and distributes to new providers
Completes re‑attestation of CAQH for providers
Completes and distributes Payor Rate Notifications for new or updated payor agreements
Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions
Assisting in the preparation for state and federal audits, responding to auditor's inquiries and preparing responses to auditor's findings
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers daily regarding credentialing and privileging issues and provides resolution as needed
Assists with managed care delegated credentialing audits; conducts internal file audits
Assists in the submission of credentialing documents for all new locations or acquisitions
Utilizes credentialing database, optimizing efficiency, performs query, report and document generation
Monitors the initial, reappointment and expiring licenses for all medical staff, professional staff and delegated providers, ensuring compliance with regulatory bodies
Participates in RCO and Credentialing meetings and ensures Credentialing functions are adhered to
Behaves in a manner consistent with Professional's mission, vision and values
Attends training classes as directed and completes assigned training courses
Maintains a working knowledge of HIPAA, OSHA, Risk Management and Compliance regulations
Practices privacy protocols in accordance with Company policies and all applicable laws and regulations
Performs other duties as assigned by the Credentialing Manager or RCO Management
Requirements
Knowledge of credentialing requirements required
At least two years of relevant healthcare experience required
Knowledge of/proficiency with Microsoft Office is required
Detail oriented and organized with the ability to work independently and in a group setting
Strong research skills to gather pertinent information
Ability to communicate effectively, both orally and in writing
Ability to establish and maintain effective and cooperative working relationships with staff and others contacted in the course of work
Ability to think and work effectively under pressure and accurately complete tasks within established times
Ability to prioritize tasks and meet deadlines
Embraces diversity within the work environment and consistently deals with internal and external customers in a friendly and respectful manner; supports teamwork and cooperation with work partners in daily activities
Benefits As a part of our team, you're eligible for:
Unmatched paid time off that includes Vacation, Sick, and Personal days!
401k Matching - It's never too early to start thinking about retirement!
Comprehensive health benefits (medical, dental, vision)
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Hourly Rate:
$24.04 - $25.90 (pay is commensurate with level of experience)
Essential Functions
Prepares credentialing files for completion and distributes them to new providers
Coordinates and monitors the review and analysis of clinicians' re‑credentialing and accompanying documents, ensuring provider eligibility
Works with the RCO and Credentialing team on various credentialing functions, regardless of payer. Follows determined processes to monitor and maintain systematic and timely credentialing
Follows departmental standards and policies and procedures to ensure the accuracy of credentialing data in Professional Physical Therapy EMR database
Leads, coordinates, monitors the review and analysis of practitioner applications, and accompanying documents, ensure applicant eligibility
Maintains fee schedule documentation pertaining to rates, rate escalators, schedule of payor contracts terms & payer policy
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up
Prepares credentialing files for completion and distributes to new providers
Completes re‑attestation of CAQH for providers
Completes and distributes Payor Rate Notifications for new or updated payor agreements
Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions
Assisting in the preparation for state and federal audits, responding to auditor's inquiries and preparing responses to auditor's findings
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers daily regarding credentialing and privileging issues and provides resolution as needed
Assists with managed care delegated credentialing audits; conducts internal file audits
Assists in the submission of credentialing documents for all new locations or acquisitions
Utilizes credentialing database, optimizing efficiency, performs query, report and document generation
Monitors the initial, reappointment and expiring licenses for all medical staff, professional staff and delegated providers, ensuring compliance with regulatory bodies
Participates in RCO and Credentialing meetings and ensures Credentialing functions are adhered to
Behaves in a manner consistent with Professional's mission, vision and values
Attends training classes as directed and completes assigned training courses
Maintains a working knowledge of HIPAA, OSHA, Risk Management and Compliance regulations
Practices privacy protocols in accordance with Company policies and all applicable laws and regulations
Performs other duties as assigned by the Credentialing Manager or RCO Management
Requirements
Knowledge of credentialing requirements required
At least two years of relevant healthcare experience required
Knowledge of/proficiency with Microsoft Office is required
Detail oriented and organized with the ability to work independently and in a group setting
Strong research skills to gather pertinent information
Ability to communicate effectively, both orally and in writing
Ability to establish and maintain effective and cooperative working relationships with staff and others contacted in the course of work
Ability to think and work effectively under pressure and accurately complete tasks within established times
Ability to prioritize tasks and meet deadlines
Embraces diversity within the work environment and consistently deals with internal and external customers in a friendly and respectful manner; supports teamwork and cooperation with work partners in daily activities
Benefits As a part of our team, you're eligible for:
Unmatched paid time off that includes Vacation, Sick, and Personal days!
401k Matching - It's never too early to start thinking about retirement!
Comprehensive health benefits (medical, dental, vision)
#J-18808-Ljbffr