Credentialing and Enrollment Coordinator

As part of our DMEPOS organization’s operations team, the Credentialing and Enrollment Coordinator will work alongside our Compliance Manager to ensure that our practices meet regulatory requirements, implement policies effectively, manage our contracts and mitigate risk within our healthcare operations. The Compliance Specialist will also work directly with our clinical and sales field representatives to monitor compliance and effectiveness. The ideal candidate must be self-motivated, comfortable working independently, and eager to take initiative.

Key Functions:

· Assist in the continued development, modification and implementation of the overall Compliance Program including our Compliance Program training, audits, investigations and the development of policies and procedures, including HIPAA Compliance.

· Directly responsible for reviewing, analyzing and maintaining contracts to ensure they align with legal requirements and company standards.

· Develop relationships with payers to obtain, maintain and negotiate contracts and fee schedules.

· Perform all required credentialing, revalidation and accreditation applications to maintain compliance with various payers and governing bodies

· Renew and maintain all certifications, licenses, and registrations for the organization.

· Review and understand complex state and federal laws, regulations and Medicare billing policies related to DMEPOS suppliers, and make sure Synergy is always in compliance with our policies and procedures, especially as they relate to Medicare Supplier Standards, HIPAA privacy and security, and DME licensure. Frequent internal audits will need to be initiated, and outcomes addressed and corrected.

· Strategically and creatively address compliance challenges by planning, designing, implementing, maintaining and monitoring the Compliance Program while working effectively with key internal billing employees and Synergy’s field sales and service teams.

· Ensure that the company complies with federal, state, and industry regulations

· Promote ethical conduct and a commitment to compliance integrity programs

Competencies

· Excellent organization and personal and verbal communication skills

· Ability to strategically and creatively address compliance challenges

· Knowledge of DMEPOS laws and regulations

· Familiarity with operational, financial, and quality assurance procedures and regulations

· Ability to use independent judgement and discretion

· Problem solving skills and techniques

Qualifications

· Bachelor’s degree in Public Health, Healthcare Administration, Legal Support and Services, or a related field

· 5 years’ experience working within a healthcare organization

· 3-5 years experience working in compliance or credentialing

· Proficient in Microsoft Office