Credentialing Coordinator

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Responsible for supporting the JHACH practitioners as outlined in the Medical Staff Bylaws, policies, delegated plans and related contracts in all credentialing, privileging and enrollment functions. Ensures ongoing compliance with the accrediting and regulatory agencies i.e. TJC, NCQA, CMS, URAC and state regulations. Works under minimal supervision specifically with the Medical Staff Services, the Managed Care Department and the Billing Department on issues and processes which directly impact practitioner credentialing, privileging and payer enrollment. Immediate responsibility for all practitioner credentialing, privileging and enrollment related functions including completion in timely manner. Handles sensitive information and peer protected data with the highest degree of confidentiality, security and sensitivity.

Hours: Full Time/40 Hours Per Week

Work Setting: Hybrid

Shift: Flexible Monday-Friday.

Location: St. Petersburg, FL

KEY ACCOUNTABILITIES:

1. Responsible for all duties associated with the practitioner initial credentialing and re-credentialing process focused on accurately, timely completion to ensure expedient medical staff and enrollment credentialing
2. Maintains accurate and up to date files for credentialed, privileged and/or enrolled practitioners in the Morrissey (MSOW) and Apogee software system
3. Completes initial and re-credentialing applications for external facilities for which JHACH contracts for specialty physicians to provide care
4. Maintains and applies advanced knowledge of accreditation and regulatory standards related to the medical staff, credentialing, enrollment, delegated credentialing, delegated agreements, privileging, peer review functions
5. Prepare and present medical staff credentialing files to the Standards &Credentials Committee and enrollment credentialing files to the Delegated Credentialing Committee
6. Follows-up and resolves payer denials related to enrollment credentialing and works with Managed Care Department to monitor and resolve third party billing and compliance issues
7. Ensures compliance with delegated plan agreements, delegated policies and procedures including submission of monthly, quarterly and yearly roster
8. Coordinates the process for obtaining certificates of insurance from the Risk Department for new practitioners prior to hire date
9. Works independently and in a team based collaborative environment; prioritize and implement multiple projects

QUALIFICATIONS:

• Associates Degree in a related field
• Minimum 4 years' experience in hospital or managed care credentialing setting
• Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) preferred
• Advanced skills in Microsoft applications Word, Excel, Power Point and Outlook
• Excellent writing, grammar, spelling and communication skills

Salary Range: Minimum 22.68/hour - Maximum 36.29/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

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