What are the responsibilities and job description for the Credentialing Coordinator position at GA_SMHHS03 St. Mary's Medical Group, Inc.?
Employment Type: Full time Shift: Day Shift Description: Responsible for the efficient administration of credentialing/re-credentialing for large multispecialty medical group and multiple hospital facilities. Coordinates the application and renewal of insurance credentialing and enrollment for multiple third-party payers. Maintains a variety of databases to support the credentialing and enrollment functions; acts as a liaison for providers, operations, revenue site operations, and professional billing for credentialing and enrollment processes. Provides dedicated support to the professional coding and billing teams. 1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. 2. Coordinates the third-party payor credentialing and re-credentialing processes for Medical Group Providers, including problem investigation and resolution. 3. Initiates the process to gather necessary documents to ensure efficient credentialing including provider's CV, state licensure, DEA, Board of Pharmacy and Proof of Malpractice, etc. 4. Coordinates the facility privileging and re-privileging processes for Medical Group Providers, including but not limited to: a. facilitates information collection, b. completes application forms, c. coordinates submission of applications, and d. supports necessary follow-up, problem investigation and resolution. 5. Facilitates malpractice application and renewal processes for all employed providers, including annual updates to payers and healthcare facilities. 6. Maintains files, database, and hard copy of each provider’s application. 7. Maintains and updates payer rosters. 8. Utilizes knowledge of payer contracts and reimbursement. 9. Works closely with leadership and various departments to maintain on-going communication regarding process status. 10. Builds working relationships with and conducts on-going communication with carrier representatives, facility Medical Staff representatives, providers, Practice Leaders, and Administration. 11. Provides real-time communication updates regarding provider credentialing status and/or payer requirements to appropriate Professional Billing representatives and Operational leaders, including managers, directors, and other administrative leaders. Once provider number is received, communicates with Clinical Informatics Department. Confirms provider number is entered into practice management system timely and accurately. 12. Coordinates the National Provider Identification application process for all new hire providers. 13. Performs CAQH updates and maintenance. 14. Sets up and maintains electronic provider credentialing files. 15. Manages provider and other various databases; performs data entry and assists in managing and maintaining the provider database. 16. Provides dedicated support to the Professional Billing Department. 17. Other duties as needed and assigned by the manager 18. Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Our Commitment to Diversity and Inclusion Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.
