What are the responsibilities and job description for the PHO Credentialing Coordinator (hybrid), full time, days position at Holland Hospital?
CURRENT HOLLAND HOSPITAL EMPLOYEES- Please apply through Find Jobs from your Workday employee account.
Oversees the Credentialing program for Holland Physician Hospital Organization (PHO) providers. Coordinates closely with Holland Hospital Credentialing and Medical Staff Offices, working collaboratively to support the quality program and initiatives including compliance with accreditation standards and survey preparation and participation.Education:
High School Diploma required.
Bachelor's Degree preferred.
Prior experience desired.
Employment Type: Full-time
Shift: Mon-Fri
Weekly Scheduled Hours: 40
Weekend Frequency: N/A
Requirements:
- High school diploma/GED or higher education
Demonstrates EXCELLENT communication and organizational skills with high degree of sensitivity to handling confidential information. Completes, organizes, and maintains department files accurately and timely.
Initial & Re-credentialing of Holland PHO providers
- Maintains expert working knowledge of Medical Staff Bylaws, accreditation standards and state/federal laws
- Uses critical thinking skills to complete and process all applications accurately and timely in accordance with rules and regulations, including identifying and communicating concerns and conducting follow-up on missing items
- Ensure Medical Staff Office has documented minutes for PHO Credentialing Committee meetings per Holland Hospital sub-delegation agreement, including initiating off-cycle e-Votes and documenting minutes for Holland PHO Board of Directors
Primary source validation on behalf of contracted payer delegation agreements
- Maintain applicable departmental policies and procedures in accordance with rules and regulations as set forth in NCQA and payer guidelines
- Conduct and oversee Audits related to the Credentialing program
Payer Enrollment (shared responsibility)
- Collaborate with Holland PHO practice management staff and providers related to the credentialing and contracting process in an accurate and timely manner
- Provider roster creation & validation
- Provider directory maintenance, including payer Find A Doc tools
- Occasionally meet with payer representatives to resolve issues
Conduct site visits at Holland PHO practices to attest to requirements related to Credentialing and Delegated agreements
Support Holland PHO practices in issue resolution related to provider status as it relates to billing efficiency
Holland Hospital is an Equal Opportunity Employer, please see our EEO policy
