Credentialing Coordinator - Summit Medical Group Job at Summit Medical Group
Overview:
Summit Medical Group is East Tennessee’s largest primary care organization with more than 375 providers at 82 practice locations in 16 counties. Summit also consists of four diagnostic centers, mobile diagnostic services, eight physical therapy centers, four express clinics, central laboratory, and sleep services center. Summit provides healthcare services to more than 280,000 patients, averaging over one million encounters annually. For more information, visit www.summitmedical.com
In addition to our commitment to the health of our community, our organization is also committed to the health of our employees through our employee Wellness Program. Employees receive a discounted monthly insurance premium if they actively participate in the wellness program. Furthermore, Summit Medical Group hires only non-tobacco users. Pre-employment drug testing will include testing for nicotine, and only candidates who pass the drug test will be considered eligible for employment. Responsibilities:
Summit Medical Group's Corporate Office is seeking a Credentialing Coordinator to ensure that paperwork, documentation and credentials of Summit physicians are processed and forwarded as required by appropriate agencies and healthcare insurance companies. This is a Full time position.
EXAMPLES OF DUTIES: (List does not include all duties assigned)
Qualifications:
Experience: Clinical experience preferred. Insurance company/managed care procedural experience preferred.
About Summit Medical Group
Summit Medical Group is East Tennessee’s largest primary care organization with more than 375 providers at 82 practice locations in 16 counties. Summit also consists of four diagnostic centers, mobile diagnostic services, eight physical therapy centers, four express clinics, central laboratory, and sleep services center. Summit provides healthcare services to more than 280,000 patients, averaging over one million encounters annually. For more information, visit www.summitmedical.com
In addition to our commitment to the health of our community, our organization is also committed to the health of our employees through our employee Wellness Program. Employees receive a discounted monthly insurance premium if they actively participate in the wellness program. Furthermore, Summit Medical Group hires only non-tobacco users. Pre-employment drug testing will include testing for nicotine, and only candidates who pass the drug test will be considered eligible for employment.
About Our Career Opportunity
Summit Medical Group's Corporate Office is seeking a Credentialing Coordinator to ensure that paperwork, documentation and credentials of Summit physicians are processed and forwarded as required by appropriate agencies and healthcare insurance companies. This is a Full time position.
EXAMPLES OF DUTIES: (List does not include all duties assigned)
Submits for and maintains all appropriate Medicare billing numbers – individual and Submits all applications for ancillary/electronic media.- Anticipates credentialing needs by being abreast of new recruits, new acquisitions, Seeks out that type information in order to stay in the loop.
- Handles confidential matters concerning physician credentialing, malpractice issues, etc with the strictest of confidentiality.
- Updates/informs the sites, department supervisors (A/R, Acctg, Operations) and others of credentialing issues, par status, etc.
- Attends timeline meetings on new site acquisitions; reports on major points, actions resolved or to be taken. Sets, meets deadlines for credentialing of new sites. Communicates par status to new site managers.
- Handles variety of matters involving contact with various staff, committee members, insurance payors, government agencies, and others.
- Composes correspondence and disseminates to appropriate individuals, payors, staff, physicians, etc.
- Prepares and maintains matrix of participating insurances by Disseminates to appropriate recipients, i.e., AR staff, site mgrs, etc.
- Prepares and maintains matrix of hospital affiliations/privileges by Applies for privileges, recredentialing, as needed.
- Monitors the current status of malpractice coverage for all providers - doctors and nurse Ensures the appropriate follow-up when needed.
- Prepares and maintains matrix of MD licenses and DEA’s by doctor to ensure no lapse in coverage. Ensures the appropriate follow-up to the site mgrs, when needed.
- Monitors the current participating status of all nurse practitioners and applies for par status, as needed, especially related to Medicare. Ensures follow-up when needed.
- Is attentive to details when completing Does so w/ timeliness and accuracy.
- Resolves issues independently, initiates credentialing needs, determines action necessary, and handles matters not requiring executive disposition.
- Maintains good relationship with all network physicians and their office staff.
- Reviews returned applications for completion and obtains any required information & items needed. Prepares applications for submission to outside credentialing agency.
- Receives verified applications from outside credentialing agency; reviews for completeness and timeliness of dates, looking at verifications.
- Prepare accordingly for insurance company audits of delegated Work with insurance company auditors to facilitate audits.
- Upholds the standards of the company’s reputation as one of integrity and equity within the medical and professional community.
- Actively participates in site-level Quality Improvement Each employee will contribute to the continual evaluation site performance as well as the implementation and measurement of improvement activities that increase the quality of care provided to patients.
- Adheres to all appropriate aspects of the corporate compliance plan.
- Performs related tasks as appropriate.
Qualifications:
Education: High School Diploma required, vocational or college credits preferred.
Experience: Clinical experience preferred. Insurance company/managed care procedural experience preferred.
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