What are the responsibilities and job description for the Senior Provider/Payer Credentialing Coordinator position at Columbia Graduate Consulting Club?
- 545765
- Other US Locations, Campus
- Parker Plaza, Fort Lee, NJ
- Faculty Practice Organization
- Full Time
- Opening on: Aug 23 2024
- Grade 104
- Job Type: Officer of Administration
- Regular/Temporary: Regular
- Hours Per Week: 35
- Standard Work Schedule: M-F, 9AM-5PM
- Building: 400 Kelby street, Fort Lee NJ 07024
- Salary Range: $75,000 - $80,000
Position Summary
The Provider Enrollment Group (PEG) is the central ColumbiaDoctors unit responsible for payer credentialing and enrollment services. The Senior Provider Enrollment & Credentialing Coordinator performs analytical provider enrollment and credentialing functions with payers, vendors, and practices.
Responsibilities
Technical
- Prepares, submits, and tracks payer enrollment and credentialing material submissions. Identifies variances, issues, and delays, addressing them in a timely manner, escalating with internal and external stakeholders and management as needed.
- Performs ongoing outreach and follow-up with providers, payers and vendors, ensuring that contractual obligations in terms of turnaround timeframes, credentialing and loading requirements are met, escalating when deficiencies are identified.
- Audits materials returned by providers, payers, and vendors for accuracy and completeness, addressing variances in a standardized way according to well-defined standard operating procedures.
- Prepares and distributes status updates to stakeholders for accurate and timely updating of internal and external platforms (including but not limited to databases, credentialing grids, dictionaries, portals, and websites).
- Serves as a key contributor to special credentialing, enrollment, and operational projects, including large-scale initiatives and centralization of additional services and functions.
- Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures. Proficient in excel to utilize v-lookup, pivot tables, concatenation, and other reporting tools to validate data from multiple sources.
- Serves as the primary point of contact for providers, payers, and vendors. Leads regular meetings to discuss the status of open items and deliverables, preparing agenda in advance, and following-up with meeting minutes. Escalates to internal and external stakeholders as needed.
- Troubleshoots credentialing associated denials/underpayments, collaborating with stakeholders to complete a comprehensive root-cause analysis, following through to resolution to minimize adverse impact to revenue and patient/provider abrasion.
- Identifies trends impacting multiple providers, payers and/or groups. Prepares and distributes status reports, making recommendations for next steps and escalating to internal and external stakeholders.
- Performs scheduled and ad-hoc audits of payer and vendor data ensuring updates are made in credentialing database and discrepancies are addressed with external parties.
- Administers credentialing processes in accordance with NCQA guidelines, including quality assurance and compliance tasks, delegated credentialing payer audits/reporting, and coordination of Credentialing Committee processes.
- Collaborates on cross-functional projects, delegating tasks as deemed appropriate, asking for guidance when required and provides cross-coverage for a wide range of related responsibilities.
- Establish and maintain positive relationships with payers, providers, practices and administration, providing subject matter expertise and tailoring communications to adapt to each audience.
- Effectively communicates through informal and formal presentations for various audiences to ensure relevant communication are cascaded to the various interest and stakeholder groups as needed.
- Works collaboratively with fellow team members to regularly evaluate the
- effectiveness of department Standard Operating Procedures and workflows and identify gaps. Provides feedback and recommendations to supervisor for improvements. Implements approved changes.
- Mentors others in individual and team accountability, modeling behavior, and demonstrating best practices/techniques.
- Performs other related duties as assigned within the scope of practice.
- Maintain familiarity and stay current with NCQA requirements and health insurance plan procedures.
- Represents PEG on committees, task forces, and workgroups as assigned.
- Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.
- Bachelor’s degree or equivalent in education and experience.
- A minimum of 3 years of related experience.
- An equivalent combination of education and experience will be considered.
- Must demonstrate advanced analytical and problem-solving skills with attention to detail and accuracy.
- Advanced time management skills including planning, organization, multi-tasking, and ability to prioritize required.
- Must demonstrate effective communication skills both verbally and written.
- Specialized knowledge of managed care Credentialing/Enrollment.
- Intermediate knowledge of Microsoft Excel (e.g. vlookup, pivot tables, etc.) or similar software is required.
- Must be a motivated individual with a positive and exceptional work ethic.
- Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
- Must successfully complete systems training requirements.
- NAMSS Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM) preferred.
- Prior experience with IntelliCred, Cactus or similar credentialing systems is preferred.
- Prior experience at an academic medical center or health insurance plan is preferred.
Core Competencies
Accountability & Self-Management
Level 3 - Intermediate
Adaptability to Change
Level 2 - Basic
Communication
Level 2 - Basic
Customer Service-Patient Focus
Level 3 - Intermediate
Emotional Intelligence
Level 2 - Basic
Problem Solving & Decision Making
Level 3 - Intermediate
Productivity & Time Management
Level 3 - Intermediate
Teamwork & Collaboration
Level 2 - Basic
Quality & Compliance Focused
Level 3 - Intermediate
Leadership Competencies
Performance Management
Level 2 - Basic
Equal Opportunity Employer / Disability / Veteran
Columbia University is committed to the hiring of qualified local residents.
Salary : $75,000 - $80,000
