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Credentialing Coordinator

Company: Brown & Toland Physicians
Location: Oakland
Posted on: May 17, 2022

Job Description:

Job Summary

  • The Credentialing Coordinator for Brown & Toland Physicians will be responsible for enrolling new and established Brown and Toland Physicians employed and contracted providers with all types of health plans; maintains the initial enrollment, revalidation, and termination of health plan provider participation.Qualifications
    • Required Education: High School Diploma or equivalent
    • Preferred Education: Bachelor's Degree preferred or equivalent combination of education, training and experience.
    • Minimum Experience: 2-4 years of related healthcare experience, IPA or physician practice experience in an operational role preferredJob Duties and Responsibilities
      • Facilitates, completes, maintains the enrollment application process for all employed and contracted BTP healthcare providers (medical doctors and advance practice providers) with the various commercial, managed care, and governmental payors.
      • Maintains the database including but not limited to data entry, scanning documents and maintaining data sufficient to pre-populate applications supported by the database.
      • Works with payers to facilitate issue resolution, re-enrollment, and termination requirements.
      • Coordinates responses to inquiries regarding payer's inquiries; follows up with each payer and or provider to completion; assesses provider credentialing files to determine if additional information is required; revisits state and federal bulletins for provider sanctions.
      • Maintains BTP provider enrollment database in applicable BTP computer system(s).
      • Coordinates responses to inquiries regarding enrollment inquiries.
      • Corresponds with providers, staff, and network provider relations staff to coordinate/confirm network provider participation; communicates to internal and external customers' provider enrollment information and status.
      • Completes dis-enrollments, notifies health plans of termination/resignations.
      • Reviews and processes mail and/or interdepartmental correspondence as received.
      • Participates in surveys by regulatory bodies (TJC, NCQA, CMS, federal and state) and health plan audits.
      • Performs other duties as required.People Management Responsibilities
        • This position does not have people management responsibilities.Knowledge, Skills and Abilities
          • Excellent computer skills including Microsoft Office (Word, Outlook, Excel, PowerPoint).
          • eVIPs credentialing platform experience highly desired.
          • Use independent judgment and initiative within established policies and procedures.
          • Ability to Interact and maintain excellent relationships with all levels of staff and management and external contacts to support compliance and high levels of service.
          • Excellent communication skills, both written and verbal.
          • Excellent organizational skills.
          • Ability to obtain, synthesize and analyze data and recommend solutions.
          • Ability to work on multiple projects concurrently.
          • Ability to draft materials, including presentations, handouts and communications.
          • Possesses a learning and growth mindset; creative thinker.Physical Requirements and Work EnvironmentThe physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
            • Activity: Sit: Continuously (more than 2/3 of the work shift)
            • Activity: Stand: Occasionally (up to 1/3 of the work shift)
            • Activity: Walk: Occasionally (up to 1/3 of the work shift)
            • Motion: Bend/Twist: Up to 1/3 of time
            • Motion: Carry/Lift: Up to 1/3 of time
            • Motion: Reach: Up to 1/3 of time
            • Motion: Squat: Up to 1/3 of time
            • Use of Hands (Left/Right): General Motor Function
            • Use of Hands (Left/Right): Precise Motor Function (Or Fine Manipulation)
            • Use of Hands: Repetitive Motion: 1/3 or more of time
            • Weight Lifted/Force Exerted: Up to 10 lbs: Up to 1/3 of time

Keywords: Brown & Toland Physicians, Oakland , Credentialing Coordinator, Other , Oakland, California

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