Position Summary: The Credentialing Coordinator will primarily handle all credentialing for ENTA Physicians. They are responsible to process both the initial and on-going provider applications to insurance companies, hospitals, and surgical facilities. They will perform a variety of clerical and administrative duties that are necessary to run the practice efficiently.
Reports To: Credentialing Coordinator reports directly to the CBO Director
Flexibility: While this job description is meant to provide an overview and specific responsibilities of the Credentialing Coordinator, ENTA Management reserves the right to make changes, adjustments, and revisions, as needed, to this document and will coordinate such modifications with ENTA’s Practice Administrator and Physicians. While the normal work week is 40 hours, you may be subject to overtime (not to exceed 50 hours per week).
Summary of General Duties:
- Physician Credentialing (all providers)
- Process initial and re-credentialing provider applications.
- Conducts primary source verification via various state and national sources.
- Responsible for credentialing, linking, and revalidating physicians and the overall ENTA group with commercial and government insurance payers.
- Maintains working knowledge of various provider credentialing and payer credentialing policies and required procedures/forms.
- Data entry of provider demographics and payer credentialing linking information in the credentialing software
- Maintain databases and file documents.
- Answer telephones and take messages or transfer calls.
- Use computer software to create spreadsheets.
- Prepare reports and documents for Leadership team.
- Investigating provider participation with insurance plans when needed.
- Assisting the CBO Director with insurance contracting when appropriate.
- Other duties as assigned.
Working Environment:
- Physical demands:
- Average percent of time during regular shift devote to:
- Walking, Squatting, Sitting, Bending, Reaching: 75%
- Standing: 25%
- Average lifting requirements:
- Lifting Requirements: 20-40 lbs.
- Frequency of Lifting: 0-25% of the time
- Additional physical demands:
- Ability to grasp with both hands; pinch with thumb or forefinger; turn with hand/arm; reach for (above shoulder height).
- Ability to type 60 wpm.
- Ability to operate multi-line telephone system, computer keyboard and ten-key adding machine.
- Visual, Hearing, and Mental demands: Vision adequate to perform essential functions such as read telephone displays/computer terminals for long periods of time, correctable to 20/20. Hearing is adequate to perform essential functions such as answering the telephone. Mental capacity adequate to perform essential functions such as quickly and accurately entering patient demographics and scanning documents while checking in multiple patients. Tact to deal with unfriendly individuals regarding various situations, and adequately handle stress.
- Working Conditions: This position has an option to work from home after training has been completed. Performance, reliability, and overall fit for the role will be assessed prior to an employee being given permission to work remotely and will continue to be assessed once the employee has gone remote. Required to exhibit a positive attitude and a professional appearance and show detail and accuracy. Required to exhibit quality performance of the essential job functions to help the practice run effectively and efficiently.
Position Requirements:
- High School education or GED equivalent.
- Minimum of 2 years’ experience in medical office or related business office
- Minimum of 2 years’ experience in medical provider credentialing.
- Previous experience with medical credentialing.
- CAQH website navigation and information submission knowledge.
- Insurance online web portals and application submission.
- Computer literate—with keyboard skills and knowledge of practice management and word processing software
- Solid understanding of scheduling efficiency and patient flow in a medical practice
- Good analytical and problem-solving skills
- Ability to prioritize workflow in a fast-paced environment
- Ability to communicate effectively with patients, physicians, and staff in a courteous manner.
- The ability to attend work on a regular basis
- The ability to adhere to safety rules and other reasonable regulations pertaining to the job
- The ability to refrain from negativity or excessive irritability
- The ability to work in cooperation with other staff, leaders and physicians.