• Robert Wood Johnson Physician Enterprise
  • $63,000.00 -95,940.00/year*
  • Trenton, NJ
  • Advertising/Marketing/Public Relations
  • Full-Time
  • 29 Thropp Ave

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Job Details:
  • High School/GED
  • General Summary:

    The Credentialing Coordinator is responsible for maintaining the credentialing process and provider enrollment with all health plans. Responsibilities include and are not limited to coordination and resolution of enrollment issues with all payers. This includes ensuring applications, reappointments, renewals and changes are processed and completed within state and regulatory standards.

    Duties and Responsibilities:

    Performs provider enrollment functions, including but not limited to: CAQH and PECOS on line application systems including enrollment for commercial, State, and Federal payers Respond and address inquiries and requests including but not limited to resolution of issues, concerns and status updates from office staff, providers, and practice leadership Establish effective working relationships with payer contacts Initiate appeals and reprocessing of accounts receivables affected by payer deficiencies with links, enrollments, and fee schedule discrepancies Contribute to the Revenue Cycle process with a collaborative approach Conduct Hospital privilege enrollments for provider specialists Coordinate enrollment of malpractice insurance for all providers Contribute to the enrollment process of payer incentive programs Utilizes the credentialing database to prepare and maintain physician profile ensuring file completion within time periods specified Utilizes the credentialing database, optimizing efficiency and performs query, report and document generation Coordinates and monitors the review and analysis of practitioner applications and accompanying documents. Support the provider with completion of applications for appointments and reappoints to the medical staff, licensing, DEA and CDS renewal Responsible for prompt notification of ID numbers received and resolution of any irregularities Identifies and communicates issues that require additional investigation and evaluation, validates discrepancies and ensure appropriate follow up Respond to inquiries from healthcare organizations, interfaces with internal and external customers on day to day credentialing and privileging issues as they arise Ensures practice and physician information is current with health plans, agencies and other entities. Other duties and responsibilities as assigned

    Education and Experience:

    High School Diploma or equivalent

    Associates Degree preferred

    Twoyears of relevant credentialing experience preferred

    Knowledge, Skills and Abilities:

    Proficient in provider enrollment and billing processes and procedures

    Knowledge of medical credentialing and privileging procedures and standards

    Proficient with OneApp credentialing software

    Database management skills including querying, reporting and document generation

    Strong Oral/Written communication skills

    Well organized and detail oriented

    Ability to efficiently and effectively manage multiple tasks

    Ability to prioritize work and manage multiple priorities Ability to research and analyze data Ability to work independently with minimal supervision Proficient use of Microsoft Office

    Physical Demands:

    Individuals must be able to meet established specific physical requirements of the job including sitting at a desk or meeting table, reaching, lifting, pulling, bending, stooping, twisting, standing and walking

    Working Conditions:

    Office environment

  • * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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