Your Next Mission is Here

AdventHealth Careers for VeteransCredential Coord Senior Pay
Centennial, CO

Our Mission is to extend the healing ministry of Christ.

We are more than healthcare. We are a family of caregivers who see what we do as a calling and treat every person, every time as if they were a loved one. We don’t just heal what hurts. We ease minds and encourage spirits by providing a more personal level of care than ever before—physically, emotionally, and spiritually. Our mission is to Extend the Healing Ministry of Christ which starts with caring for others with uncommon compassion and going above and beyond to make those we serve, feel loved.

Wellness is at the core of what we do, focusing on living a better life today and always. We want everyone to Feel Whole and we see our work as a calling. This is how we make a difference. With our whole-person care, expertise and world-class resources we strive to provide an exceptional experience for all. With hospitals and facilities in over 9 states, our consistent approach to healthcare allows us to live our mission and ensure that our communities are living fuller, healthier lives.

GENERAL SUMMARY:

This position has dually aligned responsibilities, while striving for excellent quality of patient care; 1). Credentialing & On-Boarding: Manages an assigned territory/region as the key liaison, responsible to work with AdventHealth Physician Group’s Operations and Clinic Transitions teams to ensure a smooth on-boarding experience for our providers. Coordinates a comprehensive specialized credentialing program to assure compliance with the payer credentialing requirements and delegated carrier agreements and NCQA requirements that are built into our policies and procedures. Manages our NCQA certification, and annual delegated commercial payer audits assigned., and 2). Facility Credentialing & Privileging: Coordinates and completes all required medical staff and health professional applications, forms and delineation of privileging information for our medical staff partners.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES :

· Manage an assigned territory/region of providers, completing all commercial delegated credentialing requirements, collection of all government enrollment materials, to ensure meeting the targeted employment effective date; At-risk priority: on-going monitoring to meet effective dates, avoid claim revenue losses, referral/preauthorization’s, continual communication with operations, recruiting and new providers.

· Communicates with AHMG leadership to escalate slow or non-responsive providers who are at risk of meeting their assigned employment effective dates.

· Coordinates and manages communications through MD-Staff and SmartSheet with multiple on-boarding teams, validation of accurate information, tracking step-by-step progress on each assigned provider documented clearly; Accuracy of demographics drives our ability to collect on claims revenue, as well as reflect on AdventHealth’s website correctly for patient referrals.

· Must understand strategies of how clinics are set up, tax id#’s, group NPI#’s, to assist employed clinics as well as assist in developing opportunities for non-employed clinics (to collect on claims revenue).

· Provider liaison, fielding questions re: effective dates, malpractice coverage – follows file all the way through completion of payer credentialing and ALL facility privileges & through all governmental payer credentialing and non-delegated payer credentialing (if applicable)

· Works closely with and presents status of each assigned provider, with our on-boarding operational teams and HR/Recruitment, to ensure a smooth transition process. Attends monthly operational meetings and specific territory operational meetings to report progress on assigned providers.

· Manages the Malpractice Group coverage, application process, evaluate information reported and submit to AdventHealth’s applicable carriers for review and certificate of coverage; Manages provider’s DEA; link to appropriate clinic location for supply and pharmaceutical savings programs.

· Prepare/audit secondary review of team files, per NCQA and payer standards, creating team educational opportunities for learning.

· Responsible for assigned annual delegated payer audits; building relationships, understanding unique requirements of delegated agreements, create file review rosters, file review audit (electronically), coordinate quality reporting, review findings and respond to findings with OMA leadership support.

· Understands and engages in National Committee for Quality Assurance (NCQA) requirements, to effectively work with our delegated commercial payers. Become subject matter expert on NCQA, URAC, CMS standards, delegated credentialing policies and procedures, and update in policy software. Assist with ongoing improvements and development of AHMG delegated policies.

· Must be able to manage a high volume of provider files, while maintaining completion prior to targeted effective dates.

· Compile and authenticate Commercial Payer and Government Enrollment, Medical Staff, Allied Health applications and waiver requests in compliance with payer and regulatory requirements and accreditation standards. This includes, but is not limited to, the primary source verification of information, collection and analysis of information received, and pursuit of additional information as necessary.

· Analyze essential data within the applications and all additional relevant documentation/information to ensure compliance with all payer, NCQA, federal and state regulatory requirements, Medical Staff Bylaws and affiliated documents, and TJC

· standards for initial appointment, reappointment in an independent, efficient, and timely manner.

· Educate and then serve as the technical assistant to AHMG leadership in their evaluation of the current clinical competence of applicants and appropriateness of credentialing requests, document review, privilege form review, NCQA preparedness.

· Serve as the technical resource regarding NCQA accreditation standards, adherence to delegated policies, delegated commercial agreements, and policies and procedures governing the OMA credentialing staff.

· Responsible for effective communications and full integration of services between AHMG Executive Leadership, Operational teams, Medical Staff Departments and other components of the team.

· Ensure all information, including but not limited to licensure, certifications, and professional liability insurance for practitioners meets payer and hospital requirements, and is current and accurate.

· Prioritize multiple department tasks and projects to ensure they are completed in the required timeframes based on employment effective dates. Ability to deal with multiple tasks and interruptions with minimal supervision.

· Promote a team environment, willing to assist others, and responds timely to physicians, AHMG Operations, hospital staff and various external entities.

· Direct, educate and motivate AHMG Medical Directors and physician leaders to accomplish their assigned tasks either with matters of significance to department business or in support of the credentialing program.

· Responsible for meeting management, to include agenda development, appropriate documentation and follow-up on key issues.

· Serve as the technical expert for the credentialing software program, to include database management and generating reports for both internal and external sources.

· Triage provider, patient, commercial payers and billing satisfaction concerns and/or complaints in a timely manner, assuring they have been thoroughly addressed and responded to.

· Communicate with physician applicants and appointees, AHMG Executives and Operational teams, Medical Staff leaders, Executive Staff, Legal and Regulatory Staffs, and numerous external entities regarding demographic and competency information about AdventHealth practitioners.

· Responsible for protection of highly confidential and sensitive information including peer review and HIPAA protected information.

This job description is not intended to be an exhaustive list of all duties. Employee may perform other related duties as assigned.

KNOWLEDGE AND SKILLS REQUIRED:

· Organizational

· Verbal Interpersonal

· Customer Relations

· Grammar/Spelling

· Read/Comprehend written instructions

· Follow verbal instructions

· Keyboarding (manual)

· Computer (visual)

KNOWLEDGE AND SKILLS PREFERRED:

· Working knowledge of NCQA, URAC, The Joint Commission, CMS, and Department of Health standards.

· Successful experience with previous delegated commercial payer audits preferred.

· Proven leadership skills: ability to develop and sustain trusting work relationships, ability to educate and motivate team members, ability to communicate effectively with various levels of professionals, ability to self-regulate and meet deadlines, ability to use critical thinking and strategic approaches in problem-solving, etc.

· Proven abilities in arbitrating and negotiating issues between physicians, AHMG Operational Leadership, Delegated Commercial Payers and Medical Staff leaders/hospital departments.

· Demonstrated computer and database management skills, with previous experience utilizing credentialing software preferred.

· Knowledge of clinical/medical terminology

EDUCATION AND EXPERIENCE REQUIRED:

· Education

· Highschool Diploma/GED

· Experience

· Four (4) years of healthcare-related physician/allied health professionals credentialing experience, medical staff related experience, or degree in business administration or medical staff services management, in lieu of experience.

EDUCATION AND EXPERIENCE PREFERRED:

· Education

§ Associate's Degree or Bachelor's Degree, preferred

· Experience

§ 4-7 years of experience in credentialing/provider enrollment preferred

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

·

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

· CPMSM or CPCS certification, preferred

Qualifications

KNOWLEDGE AND SKILLS REQUIRED:

· Organizational

· Verbal Interpersonal

· Customer Relations

· Grammar/Spelling

· Read/Comprehend written instructions

· Follow verbal instructions

· Keyboarding (manual)

· Computer (visual)

KNOWLEDGE AND SKILLS PREFERRED:

· Working knowledge of NCQA, URAC, The Joint Commission, CMS, and Department of Health standards.

· Successful experience with previous delegated commercial payer audits preferred.

· Proven leadership skills: ability to develop and sustain trusting work relationships, ability to educate and motivate team members, ability to communicate effectively with various levels of professionals, ability to self-regulate and meet deadlines, ability to use critical thinking and strategic approaches in problem-solving, etc.

· Proven abilities in arbitrating and negotiating issues between physicians, AHMG Operational Leadership, Delegated Commercial Payers and Medical Staff leaders/hospital departments.

· Demonstrated computer and database management skills, with previous experience utilizing credentialing software preferred.

· Knowledge of clinical/medical terminology

EDUCATION AND EXPERIENCE REQUIRED:

· Education

· Highschool Diploma/GED

· Experience

· Four (4) years of healthcare-related physician/allied health professionals credentialing experience, medical staff related experience, or degree in business administration or medical staff services management, in lieu of experience.

EDUCATION AND EXPERIENCE PREFERRED:

· Education

§ Associate's Degree or Bachelor's Degree, preferred

· Experience

§ 4-7 years of experience in credentialing/provider enrollment preferred

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

·

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

· CPMSM or CPCS certification, preferred

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Medical Staff

Organization: RMR Region Support

Schedule: Full-time

Shift: 1 - Day

Req ID: 24003845

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

Job Snapshot

  • Job Schedule: Full-time

    Pay Range: $28.70 - $45.89

  • Location: Centennial, CO

  • Job ID: 24003845

  • Job Family: Medical Staff

  • Shift: 1 - Day

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