Job Purpose: 

The position is responsible for ensuring an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians.  The position is also responsible for ensuring that all licensure is updated and active for all of the markets and clinicians.

Additionally, this position serves as liaison between center staff, operations, billing and payers, answering questions about payer contracts, fee schedules, CMS issues, and maintaining all files.

Essential Functions:

• Responsible for documenting and tracking all credentialing, re-credentialing, and hospital privileging activities within the Symplr IntelliCred software environment.
• Maintain and monitor all licenses and certifications in the Provider Trust database to ensure compliance within all markets.
• Coordination of provider enrollment activities (including initial enrollments or re-credentialing) for all Centers, employed physicians, and nurse practitioners.
• Ensure all facility and practitioner licenses and certifications are accurate and in good standing at all times.
• Complete all forms and supporting documents required to obtain hospital privileges for physicians, as necessary.
• Ensure that all processing and reporting deadlines are consistently achieved.
• Meets regularly with Managed Care Supervisor and other team members to provide updates on progress and status of credentialing and enrollment matters.
• Performs any other functions as required by management.
• Regular attendance and punctuality is required.

Qualifications and Education Requirements

• At least three (3) years of experience of credentialing experience in a managed care or provider setting, including experience using a credentialing database.
• Specific knowledge of the payer environment and payer issues, particularly billing and collections.
• Ability to work a flexible schedule (including overtime, and weekends), as necessary.
• Excellent customer service and communication skills.
• Ability to work independently and as part of a team.
• Working experience with Excel spreadsheets and Microsoft Word documents.

Preferred Skills

• College degree or commensurate working experience in healthcare.
• Knowledge of basic medical terminology.
• Credentialing database experience (such as IntelliCred, E-Vips, Vistar, Cactus, Symed, etc.)

Required Competencies

Strong Business and Organizational Competence.  Exceptional Customer Service Skills.  Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking.

Physical Demands and work environment

The physical demands and work environment characteristics described here are representative of those that must be met 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.

Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing.

Work environment:  Required job duties are normally performed in a climate-controlled office environment.