Coordinator, Managed Care, Credentialing

What Managed Care contributes to Cardinal Health

Practice Operations Management oversees the business and administrative operations of a medical practice.

Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, enrollment, credentialing, and any other activity as it relates to payer interaction.

The Coordinator, Managed Care, Credentialing is responsible for ensuring an active credentialing/enrollment status with all contracted payors for all groups and providers. This position is also responsible for ensuring that all licensure is updated and active for all groups and providers.

Responsibilities

·         Responsible for documenting and tracking all credentialing/enrollment, re-credentialing/re-enrollment, and hospital privileging activities within the credentialing platform

·         Maintain and monitor all licenses and certifications in the credentialing platform to ensure compliance within all regions.

·         Participate in training sessions and special projects such as learning new system workflows, completing required training, and adopting updated processes within established timeframes.

·         Coordinate provider enrollment activities (including initial enrollments or re-credentialing) for all groups and providers.

·         Ensure all facility and provider licenses and certifications are accurate and in good standing at all times.

·         Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary.

·         Ensure that all processing and reporting deadlines are consistently achieved.

·         Meet regularly with Credentialing Supervisor and other team members to provide updates on progress and status of credentialing and enrollment matters.

·         Performs any other functions as required by management.

Qualifications

·         At least three (3) years of experience of credentialing or payer enrollment experience in a managed care or provider setting, including experience using a credentialing database.

·         Specific knowledge of the payer environment and payer issues

·         Ability to work a flexible schedule (including overtime, and weekends), as necessary.

·         Excellent customer service and communication skills.

·         Ability to work independently and as part of a team.

·         Working experience with Excel spreadsheets and Microsoft Word documents.

·         College degree or commensurate working experience in healthcare.

·         Knowledge of basic medical terminology.

·         Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)

What is expected of you and others at this level

·         Applies acquired job skills and company policies and procedures to complete standard tasks

·         Works on routine assignments that require basic problem resolution

·         Refers to policies and past practices for guidance

·         Receives general directions on standard work; receives detailed instruction on new assignments

·         Consult with supervisor or senior peers on complex and unusual problems

Anticipated Pay Range: $18.20 - $29.70

Bonus elig