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

Credentials and Experience

Special Requirements

Physical Demands

Work Environment

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

Apply now to join a great company!

Apply now to join a great company!