Credentialing Coordinator
Description:
Since 1969, OCR has been local and physician-owned with strong ties to the community. With talented, hardworking, and friendly staff, we work toward the common goal of serving residents of CO, WY, and NE with specialty-focused care. We are experiencing tremendous growth and are adding talented people in all of our locations!
The Credentialing Coordinator is responsible for all aspects of credentialing for OCR medical staff, providers, and practice locations. This includes maintaining up-to-date licensures and certifications ensuring all providers are credentialed, re-credentialed, appointed, and privileged with health plans, hospitals and ambulatory surgery centers. This position maintains accurate and detailed credentialing records, monitors Physician Board Certification status and regularly interfaces with hospitals, insurance companies and state agencies, and assists providers with completion of required forms.
To perform this job successfully, an individual must have the education and experience identified below and be able to perform each essential duty and responsibility satisfactorily, either with or without a reasonable accommodation. The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities or requirements.
Essential Duties and Responsibilities
- Handles confidential provider records and carries out necessary and related functions with discretion and professionalism.
- Completes all aspects of credentialing procedures, including but not limited to, and for, medical staff providers, insurance carriers/payers, and practice locations.
- Interprets and follows all guidelines for insurance network participation; completes enrollment applications and revalidations as applicable while ensuring that all information meets state and federal guidelines.
- Monitors and completes up-to-date credentialing requirements for medical staff member’s affiliations and clinical privileges. Promptly prepares and ensures transmission of application and related records and certifications to retain OCR provider’s medical staff status and privileges at applicable hospitals and surgery centers. Appropriately, addresses follow up issues as they arise.
- Interacts with medical staff offices, internal and external partners and government agencies to promote open and respectful communication and exchange of information.
- Revalidates OCR provider and OCR facility insurance carrier enrollments as applicable. Contacts insurance carrier credentialing departments as needed to ensure information meets carrier standards for maintaining network status.
- Expedites physician maintenance of licensure, insurance and certification to meet and/or exceed accreditation standards. Maintains accurate provider profiles on databases such as: Council for Affordable Quality Healthcare (CAQH), Provider, Enrollment, Chain and Ownership System (PECOS), and Centers for Medicare and Medicaid Services (CMS).
- Provides support services for physicians initial board certification or recertification as applicable.
- Interfaces with the OCR Business Office to promote open communication of any changes to provider and/or facility network participation of accepted insurance carriers.
- Works with Human Resources by conducting background checks on all incoming credentialed providers.
- Sustains knowledge of ever-changing accreditation standards as applicable for all credentialing tasks. Participates in professional development activities and maintains applicable professional affiliations and certifications as required.
- Attends and participates in required organizational meetings and committees as requested.
- Actively communicates with manager/team workload assignments/reassignments to expedite processing of all credentialing tasks.
- Other duties as assigned.
Education and Experience
- High School diploma or equivalent required. Advanced degree in business or related area preferred.
- Basic knowledge and understanding of medical credentialing and privileging procedures/standards and their direct impact on the practice’s revenue cycle, highly preferred.
- Two years of experience in healthcare-related field with credentialing experience preferred.
- Proficient with Microsoft Office Suite or related software and similar computer applications.
Certificates, Licenses, Registrations
- Certified Provider Credentialing Specialist (CPCS) preferred.
Core Competencies
- Detail Oriented – Consistently checks and rechecks work product for accuracy; able to manage multiple tasks while accurately performing essential job functions; prepares accurate and thorough reports, emails, and data as required by the position.
- Job Knowledge – Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; keeps abreast of current developments; requires minimal supervision; displays understanding of how job relates to others; uses resources effectively.
- Use of Technology – Demonstrates required skills; adapts to new technologies; troubleshoots technological problems; uses technology to increase productivity; keeps technical skills up to date.
- Oral and Written Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; writes clearly and informatively; edits work for spelling and grammar; able to read and interpret written information; ability to communicate with clients or customers.
- Planning/Organizing – Prioritizes and plans work activities; uses time efficiently; plans for additional resources; sets goals and objectives; organizes or schedules other people and their tasks; develops realistic action plans.
- Confidentiality – Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy. Adheres to HIPAA guidelines.
Independence of Action
Work progress is monitored by supervisor/manager; incumbent follows precedents and procedures and may set priorities and organizes work within general guidelines established by supervisor/manager.
Supervisory Expectations
This job has no supervisory responsibilities.
Travel Requirements
None
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
(The phrases “occasionally”, “regularly”, and “frequently” correspond to the following definitions: “occasionally” means up to one-third of working time, “regularly” means between half and two-thirds of working time, and “frequently” means two-thirds and more of working time.)
- The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are significant distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, loud noises, and interruptions to answer questions from others.
- While performing the duties of this job, the employee is frequently required to sit and use hands to finger, handle, or feel objects, tools, or controls up to 8 hours a day. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms, and stoop, kneel, crouch, or crawl.
- Requires the ability to work under stressful conditions and/or irregular hours to meet deadlines.
- The employee may occasionally lift and/or move up to 20 pounds and should do so in a sound and safe manner. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Benefits:
- Medical, Dental, Vision coverage
- Life and AD&D Insurance
- Short Term and Long Term Disability Insurance
- Retirement savings and profit sharing plan participation
- Employee Assistance Program
- Continuing Medical Education (depending on position)
- Paid Time Off
*Benefit eligibility is dependent on employment status, and a waiting period may apply.
Orthopaedic & Spine Center of the Rockies (OCR) is an Equal Opportunity Employer and prohibits discrimination or harassment of any kind. OCR is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual experience and qualifications, without regard to a person’s race, color, age, sex, gender identity, gender expression, marital status, sexual orientation, religion, creed, national origin, the presence of any physical or mental disability, or status as a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, or any other protected status.
Posting Information
Posting Date:
February 17, 2023
Location:
Fort Collins
Department:
Central Services
Job Information
Shift:
M-F
Pay Rate:
$17.00 - $24.50 /hour, commensurate with experience
