Summary
Serves as the Hospital’s provider enrollment coordinator for all institutional (physician groups and facilities) and professional (practitioner) enrollment activities. Manages and oversees all aspects of provider enrollment and re-enrollment with federal, managed care and other 3rd party payors. May assist in all aspects of credentialing, including appointment, reappointment, privileging and temporary privileges for Medical Staff members and Health Professional Affiliates in medical staff departments. Keeps abreast of current requirements and any changes from regulatory agencies (e.g. CMS Conditions of Participation, NCQA, State laws, and federal regulations) that impact the credentialing and provider enrollment processes and applies this knowledge to credentialing and provider enrollment practices. Ensures compliance with the Concord Hospital Medical Staff Bylaws and Rules and Regulations. Assists with accreditation survey preparation for the Medical Staff Services department and the Medical Staff.
Education
Associates degree with related experience required or a combination of education and Provider enrollment or billing experience will be considered. Bachelor's degree preferred.
Certification, Registration, and Licensure
Certified Provider Credentialing Specialist (CPCS) is preferred.
Experience
To perform this job successfully, an individual should have knowledge of Microsoft Office, Word, Excel and Access, as well as Credentialing systems. Provider enrollment experience strongly preferred.
Responsibilities
Processes necessary documents to ensure that all appropriate practitioners and institutional groups & facilities are enrolled in government programs and are participating in company approved managed care organizations.
Responds to and resolves problems with provider network participation as it relates to denial of services or reimbursement.
Maintains all internal and electronic files with appropriate provider and network participation information including the database for federal payors.
Develops and maintains positive relationships with both internal and external customers (individual
contacts for the government and commercial payors).
Manages and performs critical analysis of each initial credentialing and privileging application,
reapplication and temporary privileges for Medical Staff membership and Health Professional Affiliates (HPA) as outlined in policies.
Processes requests for credentialing, privileging, reapplication, temporary privileges, leave of absence
requests, additional privilege requests, staff category changes and resignation for medical staff
membership and Health Professional Affiliates (HPA) as outlined in policies.
Performs other duties as assigned or directed. e.g. Serves as backup to other co-workers.
Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
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Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more.
If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269.
Physical and Work Requirements
The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The Dictionary of Occupational Titles Material Handling Classification is LIGHT. The employee must regularly lift, carry or push/pull less than 10 pounds, frequently lift, carry or push/pull up to 10 pounds, and occasionally lift, carry or push/pull up to 20 pounds.
The employee is frequently required to hear and perform activities that require fine motor skills, reach, sit, and speak. The employee is occasionally required to do repetitive motion, and walk.
Specific vision abilities required by this job include color vision, depth perception, far vision, near vision, and peripheral vision.
The noise level in the work environment is usually quiet.