What are the responsibilities and job description for the Credentialing Systems Coordinator position at Medical Associates?
Medical Associates is hiring a Credentialing Systems Coordinator to join our Administration team!
What you will be doing:
Prepare, organize, and manage physician and advanced practice provider credentialing and recredentialing documents, enrollment of physicians and advanced practice providers in insurance networks, and ongoing maintenance of those documents. Own the implementation, optimization, and continuous improvement of credentialing software to enhance efficiency, automation, and compliance. This person should have the ability to dive into new software to optimize and enhance departmental effectiveness.
Benefits Package Includes:
- Single or Family Health Insurance with discounted premium rates for wellness program participation.
- 401k with immediate matching (50% on the dollar up to 7% of pay) additional annual Profit Sharing
- Flexible Paid Time Off Program (24 days off/year)
- Medical and Dependent Care Flex Spending Accounts
- Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.
Major Responsibilities:
- Act as the Subject Matter Expert for credentialing software by implementing, optimizing, and maintaining this software to ensure streamlined credentialing and recredentialing processes. Proactively identify and resolve software-related issues to ensure seamless workflows and create efficiencies as needed. Complete enrollment applications and manage progress in all insurance networks and managed care organizations in a timely, efficient, and professional manner, ensuring data integrity and accuracy within the system. Support the integration of credentialing software with other systems and train staff on best practices for utilization.
- Complete credentialing and recredentialing paperwork for physician hospital staff appointments for all hospitals and assist with nursing home credentialing paperwork. Utilize software to auto-fill repetitive fields, track status, and maintain centralized documentation for easy access and compliance.
- Work with various agencies and staff to ensure appropriate documentation is received and completed to avoid delays in physician credentialing and recredentialing. Regularly audit and update software data to maintain compliance and prevent errors. Work in conjunction with the Insurance Department to resolve complex billing issues related to provider numbers. Communicate with insurance carriers on a regular basis to maintain proper credentialing for uninterrupted claim reimbursement.
- Establish and maintain physician files with current and accurate credentials, including updating curriculum vitae and coordinating this information for physician directories. Ensure all records are consistently reflected in the credentialing system and kept up to date. Assist physicians with licensing and ensure CME requirements are met for licensing board audit purposes.
- Maintain and optimize the credentialing database, ensuring all physician credentials, personal information, provider numbers, and expiration dates are accurately recorded and monitored. Develop and oversee automated alerts for renewals and compliance tracking, ensuring proactive management of credentialing requirements.
- Provide backup coverage for the Administrative Assistants within the department.
- Complete all other assigned projects and duties.
Knowledge and Skills:
Experience Three years to five years of similar or related experience.
Education Equivalent to a two‑year college degree or completion of a specialized course of study or certification at a business or trade school.
Interpersonal Skills A significant level of trust and diplomacy is required, in addition to normal courtesy and tact. Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature. Work may involve motivating or influencing others. Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.
Other Skills Strong critical thinking skills with the ability to analyze and optimize workflows for increased efficiency and effectiveness. Identify and resolve issues proactively to enhance workflows and operations. Ability to dive in and learn new software to optimize systems and processes. Proficient in Microsoft Word and Excel.
