Physician Credentialing Support Representative (8:30am-5:00pm)

Requisition ID
2017-11503
Shift
Day
Category
Support Services
Shift Hours AM/PM
Flexible
Department
SJ MANAGED CARE
Position Type
Regular Full-Time

Overview

 

St. Joseph’s Healthcare System is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization’s outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation’s “100 Best Places to Work in Health Care”.

 

 

Job Overview

Primarily responsible for ensuring accurate and timely contracting and credentialing of St. Joseph's hospital employed physicians into various
managed care plans and with governmental payers to ensure maximization of cash flow, while improving physician, patient, payer, and other
customer relationships.

Responsibilities

  • Provides assistance to providers in completing the CAQH (Council for Affordable Quality Healthcare) database, including educating physicians about the credentialing process and its importance. Reports any non-compliant providers to Director.
  • Responsible for assisting in the credentialing and re-credentialing process for existing and new hospital-employed physicians. Work with various providers and departments to retrieve updated information to populate the CAQH database and payer files.
  • Maintains a robust follow up process regarding plan status and tracts updates. Maintains payer credentialing timelines and informs appropriate staff of any issues regarding timely/untimely credentialing. Reports any delays or failure of plans to process applications and/or data updates.
  • Updates and maintains new database with physician credentialing information.
  • Completes work and any special projects within the time frames given.
  • Meets all required competencies for department, unit and/or hospital.
  • Responsible for performing all other duties as assigned.

Qualifications

Work requires a High School diploma or equivalent and one to two years previous work related experience. Must understand payer's
credentialing requirements and must be familiar with CAQH (Council for Affordable Quality Healthcare). Must also be able to
work/communicate with providers in a professional manner to assist in the completion of the CAQH applications.

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