Senior Provider Enrollment & Credentialing Coordinator
Company: Columbia University
Location: New York
Posted on: November 17, 2024
Job Description:
- Job Type: Officer of Administration
- Regular/Temporary: Regular
- Hours Per Week: 35
- Standard Work Schedule: M-F, 9AM-5PM
- Building: 400 Kelby street, Fort Lee NJ 07024
- Salary Range: 75,000 - 80,000
The salary of the finalist selected for this role will be set based
on a variety of factors, including but not limited to departmental
budgets, qualifications, experience, education, licenses,
specialty, and training. The above hiring range represents the
University's good faith and reasonable estimate of the range of
possible compensation at the time of posting.
Position Summary
ColumbiaDoctors is one of the largest multi-specialty practices in
the northeast and is affiliated with world-renowned Columbia
University Medical Center and New York-Presbyterian Hospital. Job
Summary The Provider Enrollment Group (PEG) is the central
ColumbiaDoctors unit responsible for payer credentialing and
enrollment services located in Fort Lee, New Jersey. The Senior
Provider Enrollment & Credentialing Coordinator performs analytical
provider enrollment and credentialing functions with payers,
vendors, and practices.
Responsibilities
Technical
- Prepares, submits, and tracks payer enrollment and
credentialing material submissions. Identifies variances, issues,
and delays, addressing them in a timely manner, escalating with
internal and external stakeholders and management as
needed.
- Performs ongoing outreach and follow-up with providers, payers,
and vendors, ensuring that contractual obligations in terms of
turnaround timeframes, credentialing and loading requirements are
met, escalating when deficiencies are identified.
- Audits materials returned by providers, payers, and vendors for
accuracy and completeness, addressing variances in a standardized
way according to well-defined standard operating
procedures.
- Prepares and distributes status updates to stakeholders for
accurate and timely updating of internal and external platforms
(including but not limited to databases, credentialing grids,
dictionaries, portals, and websites).
- Serves as a key contributor to special credentialing,
enrollment, and operational projects, including large-scale
initiatives and centralization of additional services and
functions.
- Performs compliance checks and quality assurance activities to
maintain the integrity of data and ensure adherence to standard
operating procedures. Proficient in excel to utilize v-lookup,
pivot tables, concatenation, and other reporting tools to validate
data from multiple sources.
- Serves as the primary point of contact for providers, payers,
and vendors. Leads regular meetings to discuss the status of open
items and deliverables, preparing agenda in advance, and following
up with meeting minutes. Escalates to internal and external
stakeholders as needed.
- Troubleshoots credentialing associated denials/underpayments,
collaborating with stakeholders to complete a comprehensive
root-cause analysis, following through to resolution to minimize
adverse impact to revenue and patient/provider abrasion.
- Identifies trends impacting multiple providers, payers, and/or
groups. Prepares and distributes status reports, making
recommendations for next steps and escalating to internal and
external stakeholders.
- Performs scheduled and ad-hoc audits of payer and vendor data
ensuring updates are made in credentialing database and
discrepancies are addressed with external parties.
- Administers credentialing processes in accordance with NCQA
guidelines, including quality assurance and compliance tasks,
delegated credentialing payer audits/reporting, and coordination of
Credentialing Committee processes.
- Collaborates on cross-functional projects, delegating tasks as
deemed appropriate, asking for guidance when required, and provides
cross-coverage for a wide range of related responsibilities.
- Establish and maintain positive relationships with payers,
providers, practices, and administration, providing subject matter
expertise and tailoring communications to adapt to each
audience.
- Effectively communicates through informal and formal
presentations for various audiences to ensure relevant
communication is cascaded to the various interest and stakeholder
groups as needed.
Strategy
- Works collaboratively with fellow team members to regularly
evaluate the effectiveness of department Standard Operating
Procedures and workflows and identify gaps. Provides feedback and
recommendations to supervisor for improvements. Implements approved
changes.
People
- Mentors others in individual and team accountability, modeling
behavior and demonstrating best practices/techniques.
Other
- Performs other related duties as assigned within the scope of
practice.
- Maintain familiarity and stay current with NCQA requirements
and health insurance plan procedures.
- Represents PEG on committees, task forces, and workgroups as
assigned.
- Conforms to all applicable HIPAA, Billing Compliance, and
safety policies and guidelines
Minimum Qualifications
- Bachelor's degree or equivalent in education and
experience.
- A minimum of 3 years of related experience.
- An equivalent combination of education and experience may be
considered.
- Must demonstrate advanced analytical and problem-solving skills
with attention to detail and accuracy.
- Advanced time management skills including planning,
organization, multitasking, and ability to prioritize
required.
- Must demonstrate effective communication skills both verbally
and written.
- Specialized knowledge of managed care
Credentialing/Enrollment.
- Intermediate knowledge of Microsoft Excel (e.g. vlookup, pivot
tables, etc.) or similar software is required.
- Must be a motivated individual with a positive and exceptional
work ethic.
- Must successfully complete systems training
requirements.
- Ability to work collaboratively with a culturally diverse staff
and patient/family population, strong customer service skills,
demonstrating tact and sensitivity in stressful situations.
Preferred Qualifications
- NAMSS Certified Provider Credentialing Specialist (CPCS) and/or
Certified Professional Medical Services Management (CPMSM)
preferred.
- Prior experience with IntelliCred, Cactus, or similar
credentialing systems is preferred.
- Prior experience at an academic medical center or health
insurance plan is preferred.
Competencies
Patient Facing Competencies
Minimum Proficiency Level
Accountability & Self-Management
Level 3 - Intermediate
Adaptability to Change & Learning Agility
Level 2 - Basic
Communication
Level 2 - Basic
Customer Service & Patient-Centered
Level 3 - Intermediate
Emotional Intelligence
Level 2 - Basic
Problem Solving & Decision Making
Level 3 - Intermediate
Productivity & Time Management
Level 3 - Intermediate
Teamwork & Collaboration
Level 2 - Basic
Quality, Patient & Workplace Safety
Level 3 - Intermediate
Leadership Competencies
Minimum Proficiency Level
Performance Management
Level 2 - Basic
Equal Opportunity Employer / Disability / Veteran
Columbia University is committed to the hiring of qualified local
residents.
Keywords: Columbia University, Toms River , Senior Provider Enrollment & Credentialing Coordinator, Other , New York, New Jersey
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