Medical Staff Credentialing Specialist, Sr. jobs in Rochester, NY

Description

Planned Parenthood of Central and Western New York (PPCWNY) protects and provides health care and education that empowers individuals and families. With respect. Without judgment. No matter what.

Diversity and inclusion are core values and PPCWNY strives to recruit exceptional and diverse staff. PPCWNY strives to develop staff into leaders for a diverse and global workplace.

In support of PPCWNY’s mission, the Payer Enrollment & Credentialing Specialist has responsibility for the timely completion of complex government and commercial payer enrollment applications for all clinicians within CAQH and other credentialing entities, maintaining and updating information from all providers, and credential verification is submitted and authenticated. The Payer Enrollment & Credentialing Specialist will maintain contracts with all payer sources, updating a list of paneled staff, and communicating any difficulties to management promptly. Position has remote working opportunity.

• Maintains all pertinent credentialing documentation (e.g., CAQH, ETINs)
• Verifies providers credentials by obtaining primary source verification through contracted CVO
• Recredentials provider credentials for health plans through CVO as required
• Tracks with advanced notification of all expiring licenses etc. and to function as the liaison between the practice and the insurance carriers with all matters relating to the credentialing / re-credentialing process
• Create detailed insurance matrix for each practitioner which lists the individual physician, each insurance carrier and the physician’s status with the plan (updated each time there is a change in status)
• NPI (National Provider Identifier) Management: NPI implementation and maintenance in the NPPES system
• Performs follow-up with insurance payers via phone, email, or website to resolve payer credentialing issues
• Monitors the review and analysis of practitioner applications and enclosed documents, ensuring applicant eligibility
• Work closely with site management and resources to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
• Process initial and re-credentialing applications for primary source verification as set in the CVO policy and accreditation standards for PPFA
• Initiate and hold meetings with affiliates to accurately report all payer enrollment and credentialing status while gathering pertinent affiliate updates
• Under the direction of the Regional Director, create policies and procedures for payer enrollment and credentialing
• Keep Regional Director apprised of payer enrollment and credentialing issues to mitigate risk
• Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and CMS/Medicare, Medicaid, and commercial payer guidelines
• Ability to travel to all Shared Service locates as assigned
• Maintains strict confidentiality to protected health information understands HIPAA Privacy Security policies and procedures

Other Accountability Activities

• Performs other duties as assigned
• Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs in areas such as race, gender, ethnicity, creed, sexual orientation and others

Requirements

Qualifications

Applicants must possess the following qualifications (or equivalent combination of education and experience):

Education—

• Associate or bachelor’s degree in health administration or business preferred or equivalent work experience

Experience—

• Minimum one year experience in healthcare related field required and knowledge in credentialing and malpractice insurance preferred

Certifications—

• Notary Public certification required within one year of hire.

Knowledge, Skills, & Abilities:

• Ability to organize and prioritize work and manage multiple priorities
• Must be flexible with the ability to work well in a team environment
• Strong analytical and problem-solving skills
• Strong Microsoft Office and Smartsheet experience required
• Ability to work independently with minimal supervision
• Must maintain working relationships with clinicians, physicians, management, staff, and contacts outside the organization
• Exceptional communication skills (verbal and written), interpersonal skills and English grammar and usage
• Excellent attention to detail
• Ability to read, interpret and apply policies, procedures, laws, and regulations
• Planned Parenthood seeks candidates who have experience working with diverse racial and socio-economic populations, including African Americans, Hispanics, or other racial and ethnic groups
• A commitment to Planned Parenthood of the North Country New York’s (PPNCNY) mission, vision, and values along with a commitment to providing services to a diverse range of clients and to the goals of CWNY is essential

Physical Requirements

• Possess sufficient mobility to perform the Essential Functions listed in this Job Description with or without an accommodation
• Ability to travel to all agency locations as assigned