Physician Credential Coordinator

Requisition ID
2017-11552
Shift
Day
Category
Finance
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

 

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 in order to ensure maximization of cash flow while improving physician, patient, payer and other customer relations.

Responsibilities

Maintains credentialing databases through CAQH, Electronic Univ. App. and provider numbers database in Athena to ensure all data is kept current. Is responsible for the credentialing and re-credentialing process for existing and new hospital-employed physicians. Maintains for physicians a contracting and credentials� file, which will include license, board certification, DEA certificate, payer specific identification numbers, etc. Guides physicians in completing the application, including educating physcians on credentialing process and its importance. Reports to Director any non complying phys. Develops strong working relationship with health plans, physicians and their office staff to facilitate accurate and timely credentialing Follows up with plans on application status/data updates for physicians. Reports to Director on any delays or failure of plans to process applications and/or data updates. Reviews applications for accuracy, and submits applications to payers on physicians� behalf for hospital employed physicians. Updates timely and accurately insurance plans with all physician data changes and/or additions to tax ID numbers, services locations, etc. Works and completes special projects within the time frames given and responsible for performing other duties as assigned. Meets all required competencies for department, unit and/or hospital. Responsible for performing all other duties as assigned. Special Projects

Qualifications

Work requires a High School diploma or equivalent and, Associate's Degree preferred, and up to one year of basic technical training in health care billing/customer service and three to six months of previous experience plus three months or less of on the job training and orientation.

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