Credentialing Coordinator

Ohio Gastroenterology Group is the leading provider of general advanced GI procedures with several state-of-the-art facilities throughout Central Ohio. We employ a talented team of specialists who perform more GI procedures each year than any other practice in our area.

We currently have a full-time opening for a Credentialing Coordinator.

Responsibilities

• Conducts, participates in, and maintains the Provider Enrollment Process
• Upon receipt of applications, ensures all required information is contained therein, assembles the information and prepares credentials files for submission to government and commercial payers
• Recognize potential discrepancies and adverse information and independently investigates and validates information on applications, primary source verifications, and other resources
• Identifies and reviews credentialing red flags with managers/directors
• Facilitate each provider’s Council for Affordable Quality Healthcare (CAQH) and National Provider Identifier (NPI) Accounts
• Prepares and submits data and applications to the contracted and government payers in a manner commensurate with their expectations, policies and accreditation standards
• Ensures discrepancies are addressed promptly and the proper follow-ups are completed in a timely manner
• Perform tracking and follow-up to ensure provider numbers are established and linked to the appropriate group entity in a timely manner
• Ensure that established provider numbers are communicated to the billing department and clinic managers for patient scheduling
• Maintain provider enrollment information within the credentialing database and pull reports for billing staff, directors and managers as needed
• Processes re-credentialing requests for commercial payers and revalidations for Medicare & Medicaid for all practitioners and facilities

• Conducts, participates in, and maintains Credentialing and Privileging process
• Maintain credentialing database continuously and consistently to ensure accurate and current information is available to all stakeholders
• Use database software as the single source of truth for credentialing/privileging, contracting, reporting, and training
• Determines applicant’s initial eligibility for membership/application
• Compiles, evaluates, and presents the practitioner-specific data collected for review by one or more decision-making bodies
• Analyzes application and supporting documents for completeness and informs the practitioner of the application status, including the need for any additional information
• Performs initial or reappointment/re-credentialing for eligible practitioners
• Processes requests for privileges
• Conducts, participates in, and maintains Primary Source Verification process
• Obtains and evaluates information from primary sources
• Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, and other sources
• Verifies and documents expirables using acceptable verification sources to ensure compliance with accreditation and regulatory standards
• Provides responses to external queries regarding practitioners’ status
• Conducts and maintains Current Clinical Competency Evaluations
• Facilitates completion of hospital performance evaluations (FPPE/OPPE) for Physicians and Hospital-Based APPs
• Facilitates completion of internal evaluation process for Associate Physicians, Hospital-Based APPs, and CRNAs
• Complies with State and Federal Accreditation Standards and Regulatory Requirements
• Compile practitioner sanctions, complaints, and adverse data to ensure compliance
• Demonstrate an understanding of state and regulatory standards
• Performs other duties as assigned.

Knowledge, Skills, and Abilities

• Ability to prioritize and handle several tasks for maximum workflow efficiency paying close attention to details.
• Ability to express thoughts clearly, concisely, and effectively both verbally and in writing.
• Ability to maintain confidentiality regarding legal matters, privacy issues, information technology, and data integrity.
• Excellent interpersonal communication skills, integrity, accountability, and exceptional judgment.
• Strong ability to adapt in a fast-paced, ever-changing environment.
• Fluent in English.

Credentials and Experience

• Must have high school diploma or equivalent; CPCS Certification is preferred.
• Prefer minimum two (2) years’ experience working in the credentialing and privileging field.
• Proficient in Microsoft 360 including Outlook, Excel, Word, and Teams.
• Experience with virtual meeting resources such as Team, Zoom, and WebEx.
• Prior experience with credentialing software is a plus.

Special Requirements

• Understand managed care concepts, key functions, processes, terminology, and work products.
• Understand contracting responsibilities regarding credentialing, managed care, and provider enrollment.
• Understand clinical competence evaluation concepts, key functions, terminology, and work products, including evaluation tools and techniques used.

Physical Demands

• Must be able to sit (frequent), stand (frequent), walk (frequent), stoop (frequent), bend over (frequent) and type on keyboard (frequent).
• Ability to communicate in person, by phone, and via virtual sources both verbally and written (frequent).
• Must be able to independently lift 25 lbs. (occasional).

Work Environment

• Office environment with remote work opportunity after
• Travel between offices may be required, as needed

Ohio Gastroenterology Group offers a nice life/work balance and a great benefits package that includes:

• Medical, dental and vision coverage – benefits are effective the first of the month following 30 days of employment
• Company paid life insurance and short-term disability
• Generous paid time off plans (vacation, sick, and personal)
• 7 paid holidays
• Two retirement plans:
• 401(k) plan that offers a 3% safe harbor contribution and annual profit-sharing contributions after 12-18 months of employment and 1,000 hours worked.
• Cash balance pension plan – company contributes 2.5% and offers full vesting after 3 years of employment.
• Tuition reimbursement programs
• Employee appreciation programs
• Uniform reimbursement programs
• Growth opportunities
• Learning and development training

Apply now to join a great company!

Apply now to join a great company!