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Credentialing Coordinator

Boston, MA

Posted: 01/12/2023 Industry: Professional and Administration Job Number: 15229

Job Description

Connexion’s mission is to provide "best in class" services to job seekers. We strive to achieve excellence in job placement, staffing, and recruiting services while treating candidates with the professionalism and respect they deserve.

Title: Credentialing Coordinator
Hiring Organization: Connexion Systems & Engineering
  • Duration: Perm
  • Pay rate: $ 60-75k
  • Job Location: Boston, MA
  • Job# 15229

Position Summary:
Under the direction of the Department of Medicine Administrative Director, the Credentialing Coordinator is responsible for taking the lead on the orchestration of the credentialing, privileging, and provider enrollment related to employed clinical staff as well as consultants that provide clinical services.

The Credentialing Coordinator is the “owner” of all the administrative processes tied to timely privileging and enrollment that ensure compliance with our hospital licensure and other governing bodies.

In addition, demonstrate a solid commitment to the philosophy and goals of the company's mission and recognize members’ dignity and choice in daily life. Strive to make every encounter with a member into a positive and meaningful experience and opportunity, while providing safe and efficient quality of care.

Core Competencies:
  • Ability to prioritize work and meet deadlines
  • Excellent professional communication skills - both verbal and written
  • Significant time-management and organizational skills
  • Maintain positive, professional relationships with all colleagues and other companies/institutions
  • Complete duties independently and work autonomously as well as part of a team
Position Responsibilities:
Provider Credentialing and Enrollment
  • Maintain updated and complete Department of Medicine files for approval by Credentialing Committee and the board and in keeping with State rules and regulations
  • Use credentialing software or other systems to maintain of provider credentialing information as it pertains to their privileging and provider enrollment
  • Gather and coordinate paperwork for providers to be credentialed as well at Harvard Medical School and other institutions (BIDCO/etc.); take the lead in collaborating with BIDCO regarding the company’s participation in the ACO as it relates to our credentialing and provider enrollment (work alongside the Administrative Director, Chief Medical Officer as well as the Medical Staff Coordinator in this realm)
  • Develop and submit biographies for new clinicians and clinicians that need to be re-credentialed by the Quality Board and credentialing Committee
  • Prepare promotion packets for submission to DOM at Beth Israel Deaconess Medical Center for review by Academic Promotions Committee (as needed) or other types of projects from other affiliated institutions
  • Manage third party payer credentialing process as it pertains to provider enrollment
  • Complete all organization parts of applications for new providers
  • Maintain credentialing tracking log; track dates that requests were sent to clinicians, other staff who are credentialed and 3rd parties; follow up as necessary to ensure providers are credentialed prior to start date and prior to reappointment due date
  • Ensure Medicare enrollment/linking for clinicians is completed shortly after clinicians’ starts
  • Ensure our clinicians are credentialing at the various secondary payers; fill out necessary applications and monitor to make sure they are up to date and active with the various health payers/insurances
  • Utilize credentialing software and other systems as needed to ensure provider licenses, DEAs, malpractice, and other pertinent items are current and copies have been received
  • Send and coordinate check requests to fiscal for malpractice payment and reimbursement for clinicians (this occurs on a limited basis)
  • Coordinate new hire packets including immunization records and BASICS test and work with Human Resources to ensure all appropriate forms are filled out before clinicians start
  • Participate and lead operational efficiency work groups (optional) as it pertains to credentialing and provider enrollment (optional)
  • Develop and implement systems to improve credentialing and enrollment workflows – as necessary
  • Assist with the on-boarding process for new providers to ensure smooth transition for their start as it pertains to credentialing and enrollment
  • Prioritize/tracking of credentialing files to ensure compliance with regulations
  • Collaborate with Medical Directors and Administrative Director to develop new credentialing forms and other tools to streamline the credentialing/enrollment workflows
  • Establish relationships with Finance, Compliance, Human Resources, and other departments that you interface with on a regular basis as it pertains to credentialing and provider enrollment
  • Prepare for surveys from the Department of Public Health and other state agencies that review credentialing files on a regular basis
  • Build new relationships with credentialing teams at other organizations that we interface with as it pertains to the privileging of our clinicians who may be credentialing at numerous institutions
  • Work with Administrative Director and Chief Medical Officer to ensure Medical Staff By-Laws are being followed with respect to the privileging of our clinicians
Administrative Support
  • Answer and screen incoming calls for the Department of Medicine inquiries as needed
  • Prepare reports and correspondence as requested that pertain to credentialing and provider enrollment items
  • Complete special projects as assigned
Physician Practice Support
  • Work with Administrative Director to prepare annual DOM budget as it pertains to credentialing and enrollment
  • Provide administrative support to clinicians as needed
Qualifications
  • Bachelor’s degree in Business or related field required.
  • 2-3 years of clinician credentialing experience in a hospital setting preferred’
  • Previous experience (2-3 years) related to provider enrollment or credentialing required.
  • Solid understanding of health care arena (hospital level, geriatric, or other clinical field)
  • Must be professional, proactive, collaborative, conscientious and results-oriented individual.
  • Must have an optimistic and positive demeanor, excellent oral and written communication skills, good intuition and able to adapt to changing priorities and display good and sound judgment.
  • Superb organizational skills.
  • Must have solid analytical skills.
  • Must be creative and proactive yet disciplined, discriminating and able to streamline work volume to maintain bottom line efforts during multi-tasking and daily re-prioritizing.
  • Must have ability to innovate, think strategically and conceptually, manage multiple projects simultaneously and handle challenging situations.
  • Must be able to work autonomously and as part of a team.
  • Must be motivated to learn and flexible to change.
  • Computer literacy required, experience with databases, Windows, Word, Excel, PowerPoint, and databases.

Please use the apply button to submit your resume for consideration. A Connexion Representative will contact you immediately.
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