Credentialing Coordinator

Employment Type:
Full time Shift:
Day Shift

Description:
Responsible for completion of applications for provider enrollment for Medicare, Railroad Medicare, BCBS, Medicaid, Managed Care payers, and applicable Commercial payers in a timely manner and when received, notification to appropriate staff. Maintains a working knowledge of applicable federal, state, and local laws and regulations. Coordinates communication between payers and leadership and facilitate resolution of denials. Collaboratively work with several different departments and payer contacts to ensure a timely submission of enrollment applications.

ESSENTIAL FUNCTIONS

1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

2. Understand the various payer rules, regulations, and enrollment processes.

3. Assists providers with access and maintenance of NPI and CAQH accounts as needed.

4. Coordinate and complete provider and facility enrollments as assigned.

5. Ensure all enrollment activities are completed fully and accurately based on each payer enrollment requirements.

6. Demonstrate the ability to create and maintain various internal and external enrollment spreadsheets.

7. Monitor the status of pending enrollment submissions until approval notifications are received.

8. Maintain thorough documentation of all enrollment activities completed.

9. Adapt to changes in workload and assignments and display teamwork by assisting in non-typical enrollment activities as requested and assisting in the orientation of new team members.

10. Participate effectively as a team member, specifically with Physician Services, Medical Staff Offices, Payer Strategy, CPI, and the various billing offices.

11. Use written and verbal communication to provide progress updates to system leaders related to provider enrollment.

12. Assist in the maintenance of provider information on the provider database.

13. Demonstrate self-motivation with the ability to work independently, effectively and prioritize work based on operational and financial goals/impact and make appropriate decisions within the scope of the position.

14. Educates all stakeholders on the process for provider enrollment and answer questions promptly and professionally.

15. Assist in the preparation of delegated credentialing audits and reports.

16. Recognize and report problems that may arise to their Supervisor, Manager or Director.

17. Complete provider holds and work follow up work quest as assigned.

18. Assist in gathering out-of-state enrollment documents as requested by supervisor.

19. Other duties as needed and assigned by the supervisor.

20. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

1. Must possess a knowledge of payer credentialing and enrollment through a combination of education and experience.

2. Bachelor's degree preferred

3. At least 4 years of health care operations, payer enrollment, or medical staff services experience.

4. Must possess high attention to detail with the ability to prioritize competing tasks and work independently with little oversight.

5. Must have strong interpersonal skills with a focus on customer service.

6. Must be comfortable with Excel functions and possess strong computer literacy skills.

7. Previous experience with credentialing and enrollment software (or database management) is preferred.

8. Ability to become certified if required.

9. Must be comfortable operating in a collaborative, shared leadership environment.

10. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

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.