Credentialing Coordinator

Hello humankindness Dignity Health Medical Group is the employed physician group of Dignity Health Arizona. Dignity Health Medical Group (DHMG) employs approximately 200 providers and 500 support staff that cover a wide variety of specialties. The medical group has had tremendous success over the past few years and now provides more than 73 subspecialty services. The physicians provide clinical services in their areas of specialty and many serve in pivotal academic research and leadership roles.DHMG is also heavily involved in preparing tomorrows healthcare providers. DHMG has 84 medical school students and approximately 200 residents and fellows throughout the 25 academic programs. Clinical services are complemented with translational and bench research to augment medical education for residents and students. The mission of Dignity Health Medical Group is consistent with Dignity Healths mission and St. Josephs guiding principles with a focus on innovative clinical care and the pursuit of excellence through scholarly activities. As part of the Dignity Health hospital system DHMG has full access to the staff and all facilities on our hospital campuses. This unique relationship with our hospital allows Dignity Health Medical Group to provide its patients with state-of-the-art patient services including care of the poor and disenfranchised.Look for us on Facebook and follow us on Twitter.For the health of our community ... we are proud to announce that we are a tobacco-free campus

The Credentials Coordinator is responsible for coordinating the credentialing re-credentialing and payer enrollment process for the St. Joseph's Medical Group and contracted providers in accordance with the Health Plan's Delegated Credentialing Agreements PBS Department policies and procedures industry best-practices and regulatory requirements. Responsible for the daily credentialing operations including resolution of non-responsive providers and working with various clinic managers and the hospital medical staff office to ensure successful and timely completion of the delegated credentialing and recredentialing process.

Maintains up-to-date physician database of all applications, enrollment status, demographics, medical licenses, drug
enforcement administration certificates, professional liability insurance, etc.

• Responsible for the accuracy and integrity of data entered into the credentialing database system.
• Assist in designing/compiling other data supporting various statistics utilized internally to monitor operations.
• Responsible for continuous collection of information required to comply with delegated agreements and credentialing policies.
• Conducts credentialing database training for new hires, and refresher training for existing staff. Provides input for training materials and job aids.
• Reviews applications and other data sources for accuracy and completeness prior to submitting to Health Plan.
• Acts as liaison with Health Plan representatives regarding individual credentialing applications; audits; provider load confirmation; fee schedule load issues; and addressing potential corrective action plans and monitoring for a successful resolution.
• Works independently with internal and external customers to research and resolve credentialing-related issues.
• Maintains relationships with office personnel, Legal, Regulatory and Health Plan's Provider Relations department to provide and/or obtain documentation pertinent to timely and accurate completion of the delegated credentialing process.
• Ensures compliance with delegation/credentialing standards and business requirements per the delegated Agreements.
• Coordinates with Health Plan regarding staff roster submission of new practitioners, changes to existing practitioners or provider terminations

MINIMUM 

High School Diploma / GED

Three (3) years experience in a Health Care Plan Credentialing/Provider Relations and/or auditing setting or Health Care Enrollment

Proficient with CACTUS Software or similar credentialing system

Intermediate Microsoft programs skills (MS Word Excel Power Point)

Works well under stress and with shifting priorities.

Builds successful customer relationships excellent oral and written communication skills are essential.

Knowledge of NCQA standards and Joint Commission standards.

Knowledge of commonly-used concepts practices and procedures used in health care and physician credentialing.

PREFERRED 

Bachelor's degree preferred.

Five (5) years experience in a Health Care Plan Credentialing/Provider Relations and/or auditing setting or Health Care Enrollment