Credentialing Coordinator

Description

JOB SPECIFIC EXPECTATIONS

• Reviews and processes applications for provider privileges
• Exhibits excellent interpersonal skills and ability to work effectively and efficiently with healthcare professionals and with multiple stakeholders (i.e., Ambulator Surgery Center and Hospital leadership, Providers, Billing and Payor Contracting)
• Manages expirables in a timely manner.
• Maintaining accurate records of provider credentialing files, all while adhering to strict confidentiality guidelines.
• Focuses on follow-up, follow through and achievement of stringent deadlines.
• Reviews and analyzes provider credentialing file for completeness, accuracy, issues, and changes.
• Responds to provider inquiries received by letter, phone, or internal departments.
• Administers re-credentialing of physicians and CRNAs with the same standard as initial credentialing
• Complies with HIPAA regulations
• Adheres to all company policies and procedures.
• Assist with other special projects and process redesign initiatives as requested.
• • asks or initiatives given to employees that are designed to push them beyond their current skillset, allowing them to learn new abilities, practice existing ones in a different context, and ultimately grow professionally within their roles
  • projects can include leading a cross-functional team on a new initiative, developing a training program for colleagues, researching a new market opportunity, or taking on a project requiring advanced technical skills that are not part of their regular duties.
• Performs other necessary duties as assigned.

COMPANY EXPECTATIONS

Upholds and lives the Mission, Vision and Values of WELL Health USA.

Effective Communication:

• Delivers information in a clear, concise, and compelling manner to effectively engage others and achieve desired results.
• Uses good judgment as to what to communicate to whom as well as the best way to get that accomplished.
• Speaks in a clear and credible manner, selecting the right tone for the situation and audience.
• Listens to others and allows them to make their point.
• Uses good judgment about when to share external information as well as who should be informed.
• Delivers targeted, actionable communications and invites two-way communication. 

Quality of Work:

• Has established a track record of producing work that is highly accurate, demonstrates attention to detail and reflects well on the Company.
• Is personally committed to high quality work and encourages others to have similar standards.

Process Improvement:

• Identifies opportunities for improvement and innovation
• Articulates an understanding of the rationale for change
• Removes barriers and resistance and implements desired processes or modifies desired behaviors
• Promotes innovation and continuous improvement

Time Management:

• Prioritizes tasks and manages time to ensure that deadlines are met.  
• Plans his or her time and sticks to those plans.  
• Prevents or manages interruptions until the highest priority tasks are accomplished.

Teamwork:

• Effective Team Player who contributes specific skills and compliments those of his or her team-mates
• Works collaboratively to accomplish company goals and objectives and believes they are a part of something greater than themselves.            
• Communicates in an open and candid manner and can be counted upon to fulfill any commitments made to others on the team.   
• Co-creating solutions while cooperating with others.
• Displaying energy and enthusiasm for team related activities while balancing the role of leading and following 
• Proactively works to build trust amongst members of the team and the Company.

Driving Results:

• Commits to the overall wellbeing of WELL Health USA by challenging oneself and others to excel and holding oneself and others accountable for achieving all results.
• Executes to achieve desired outcomes.
• Models’ accountability for achieving results.
• Regularly monitors performance and communicates progress.
• Sets expectations for a high standard of performance.            

Managing Multiple Priorities:

• Handles multiple assignments and priorities yet still fulfills all commitments.
• Readily accepts new responsibilities and adapts well to changes in procedures.
• Gives appropriate priorities to various work demands.

Handling Difficult Issues:

• Handles sensitive or difficult issues with grace and confidence.
• Remains clear-headed and focused and inspires others to do the same.  
• Remains objective in the face of strong emotions
• Can acknowledge strong emotions without being unduly influenced by their intensity.  

Building Company Commitment

• Demonstrates commitment, loyalty, and appreciation for the Company.
• Conveys a high level of concern for the well-being of all employees and providers helping to ensure that both their needs and those of the Company are met.  
• Consistently speaks highly of the Company, its employees, and its mission.

Requirements

MINIMUM JOB REQUIREMENTS

Education & Qualifications:

Education: High School Diploma or equivalent required.  Bachelor’s Degree preferred.

Licensure & Certifications: CPCS (Certified Provider Credentialing Specialist) strongly preferred.

Previous Experience:  At least two (2) years of experience in the healthcare or medical field, preferably in a credentialing role.

Skills:  Extremely organized, detail oriented, self-driven, able to multi-task, and work under strict deadlines. Highly effective communicator, both verbally and written, with the ability to engage multiple stakeholders in various organizations.  Excellent customer service skills and superb organizational skills.  Exhibit a high degree of confidentiality.  Motivated self-starter who can work independently and who can also take direction appropriately.  Ability to work well under pressure in a very fast-paced, high-volume environment and work as a team member in a responsible, professional, and proactive manner.  Possesses strong problem solving, critical thinking and analytical skills.

Computer Skills: The credentialing department works in a mostly paper-free environment. Previous experience with provider credentialing/enrollment software (i.e., similar to VerityStream/Salesforce) necessary.  Expertise in Microsoft Office (Excel and Word). Proficiency with standard business software (Microsoft Windows, and PowerPoint) and using a laptop and mobile device is required.