Medical Staff Credentialing Director jobs in Charleston, WV

Charleston Area Medical Center (Charleston, WV) is seeking a Credentialing Coordinator.

The Credentialing Coordinator administers the credentialing process to coordinate, monitor, and maintain facility and provider credentialing while supporting other department initiatives and projects. Analyzes and resolves problems related to physician enrollment and other activity for WVPHO members. Ensures that physicians are linked correctly to plans and products for correct claims payment and revenue. Responds to requests for verification and information from internal and external customers.

Responsibilities

• Follows up on physician enrollment status with contracted plans by building effective relationships with plan representatives to ensure that WVPHO member activities are given priority processing. Evaluates reported claim problems to determine if problem is related to enrollment or other error. Resolves enrollment error, provides plan with documentation of error and obtains plan commitment to reprocess claims. Refers non-enrollment issues as appropriate. Identifies data disparities between group contracted plan sources and Managed Care database to limit negative impact on revenue, precertification and referral denials and patient procedure cancellations. Works with plan representatives to correct errors. Identifies delays in credentialing, enrollment errors and claims payment problems and works with plan representatives to further identify root causes and resolve problems. Maintains internal database and external web module database; updates physician information in group contracted managed care plans, Medicare, Medicaid, and non-contracted carriers including demographic information, addresses changes and terminations. Coordinates enrollment and credentialing for delegated and non-delegated plans, Medicare, and Medicaid including but not limited to enrollment, payer terming and demographic changes. Follows organizational and regulatory requirements. Identifies potential problems. Proactively assists in problem resolution. Provide world class customer service via phone, virtual and in person meetings and email correspondence Ability to coordinate and complete multiple tasks, utilizing time management and organizational skills

Education: Bachelor's degree in business or healthcare administration. Substitution: May substitute 4-5 years of credentialing and project management in a healthcare environment for the Bachelor's degree Comment: • Demonstrated experience with database and supporting software including Microsoft Word, Excel and Microsoft Access. Able to perform essential functions for reporting purposes and data analysis (i.e., Create data, data sorting filtering for plan-database comparisons and reconciliations). • Excellent problem solving, communication and interpersonal skills to effectively mediate and resolve issues in a timely and cost-effective manner. • Demonstrated project management skills. • Demonstrated ability to prioritize workflow to achieve time sensitive goals. • Credentialing and/or Medical Staff Office experience preferred. • Strong project management skills. • Demonstrated human relations and effective communication skills.

To apply, visit camc.org/careers for JOB ID#22566 or by clicking this link:https://gen-camc-prd.inforcloudsuite.com/hcm/xmlhttp/shorturl.do?key=JPJ

Equal Opportunity Employer

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person