What are the responsibilities and job description for the Credentialing Coordinator (Hybrid - Troy, MI) - Health Alliance Plan position at Henry Ford Health System?
GENERAL SUMMARY:
Under minimal supervision, responsible for initial and re-credentialing functions including completion of the application and verification process, Credentialing Committee preparation and follow-up, coordination with contracting and interaction with practitioners, office staff and network representatives.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Responsible for all aspects of the CAQH credentialing application and verification process for initial and re-credentialing requests. Assess completeness of information and practitioner qualifications relative to regulatory standards and guidelines including NCQA, CMS, MDCH and HAP's established standards; maintain credentialing files according to regulatory standards and guidelines including NCQA, CMS MDCH, and HAP's standards.
- Assure all practitioner data is accurate and up-to-date in the CACTUS/symplr Provider credentialing software application, including generating and monitoring reports.
- Responsible for on-going communication with internal and external customers. Respond to all correspondence within 48 hours. Consult with management quickly if unable to resolve within expected timeframe.
- Coordinate, implement, analyze and close annual delegated audits, as assigned. As issues are identified, resolution must be documented and completed in a timely manner and in accordance with regulatory standards.
- Organize and maintain practitioner files following confidentiality guidelines.
- Extract and present key information including CAQH credentialing application and credentials, and identification of potential practitioner issues to facilitate the Credentials Committee decision-making process.
- Maintain tickler systems for follow-up of unanswered correspondence to maintain department standards for application processing time.
- Participate in all data integrity projects, as identified.
- Provide cross-coverage for other analysts, as needed.
- Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Associate's degree in business, health care or related field or four (4) years of related experience in healthcare industry, managed care experience in lieu of degree.
- Bachelor's degree in business, health care or related field preferred.
- Minimum of two (2) years of experience in managed care experience.
- Minimum of two (2) years of experience in physician credentialing.
- Minimum of two (2) years of CACTUS/symplr Provider physician credentialing software experience preferred.
- Knowledge of Council for Affordable Quality Healthcare (CAQH) Practitioner Application preferred.
- Ability to work under minimal supervision.
- Ability to perform detail work efficiently and with a high degree of accuracy.
- Excellent problem-solving skills.
- Highly organized.
- Ability to initiate and coordinate multiple projects simultaneously.
- Excellent verbal communication skills.
- Ability to interpret information and make judgments quickly.
- Ability to interact professionally with practitioners and other external customers.
- Strong quantitative and analytical skills.
- Computer proficient in Microsoft Office including; Word and Excel
- Knowledge of the principles and practices of credentialing is highly desirable.
CERTIFICATIONS/LICENSURES REQUIRED:
- Certification as CPCS (Certified Provider Credentialing Specialist) or CMSC (Certified Medical Staff Coordinator) preferred.
- Organization: HAP (Health Alliance Plan)
- Department: Provider Network Operations
- Shift: Day Job
- Union Code: Office/Non-Exempt, HAP
