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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