VMG Credentialing Coordinator
VMG Credentialing Coordinator
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Salary Not Disclosed
1 Vacancy
Job Description
At Virtua Health we exist for one reason to better serve you. That means being here for you in all the moments that matter striving each day to connect you to the care you need. Whether thats wellness and prevention experienced specialists lifechanging care or something inbetween we are your partner in health devoted to building a healthier community.
If you live or work in South Jersey exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14000 colleagues including over 2850 skilled and compassionate doctors physician assistants and nurse practitioners equipped with the latest technologies treatments and techniques to provide exceptional care close to home. A Magnetrecognized health system ranked by U.S. News and World Report weve received multiple awards for quality safety and outstanding work environment.
In addition to five hospitals seven emergency departments seven urgent care centers and more than 280 otherlocations were committed to the wellbeing of the community. That means bringing lifechanging resources and health services directly into our communities through ourEat Well food access program telehealth home health rehabilitation mobile screenings paramedic programs and convenient online scheduling. Were also affiliated with Penn Medicine for cancer and neurosciences and the Childrens Hospital of Philadelphia for pediatrics.
Location:
Lippincott 301 Lippincott DriveEmployment Type:
EmployeeEmployment Classification:
RegularTime Type:
Full timeWork Shift:
1st Shift (United States of America)Total Weekly Hours:
40Additional Locations:
Job Information:
Job Summary:
Coordinates all VMG clinicians compliance of information with the CAQH (Council for Affordable Quality Healthcare) and PECOS (Provider Enrollment Chain and Ownership System) databases to ensure accurate clinician information is in the CAQH and PECOS system such as but not limited to documents affiliations hours of operations and call coverage partners. If data is not accurate the coordinator will be responsible to update and attest appropriately to ensure timely recredentialing. Collects and analyzes information thoroughly to identify potential quality of items for processing to perform the attestation of the information timely and accurately. Works directly with the payers for verification and updates on provider information on websites. Works closely with the internal credentialing services for payer credentialing.
Job Responsibilities
Coordinates with over 550 VMG clinicians to update and maintain PECOS and CAQH to ensure accuracy of data to maintain payer credentials and recredentialing for the ability to maintain billing for services rendered to patients. Coordinates and works directly with the clinicians and practice managers for attestation of information in the CAQH system which is required every 90 days. Maintains all data in the system.
Responsible for maintaining all practice location information for ADA compliance for all payers per their request as well as the CAQH file.
Responsible to maintain and update the 855B roster of all practices locations for Medicare and Medicaid to obtain payer recredentialing for over 550 clinicians
Manages the Payer Credentialing documents folder to ensure all documents for credentialing are uploaded and maintained. Works with practice manager and/or provider to facilitate the gathering of documents for timely processing into the CAQH system.
Coordinates all quarterly payers audits to ensure accurate roster information is maintained in the payer directories via spreadsheets and faxed information received. VMGs contact for payers phone calls emails and faxed requests (demographic calls ADA forms demographic information faxes from the payers.
Works with all VMG clinicians to set up PECOS and CAQH accounts as well as establish clinician NPIs.
Participates frequently in all project related function in department and assists other team members as required.
Required Experience:
23 years progressively responsible experience in payer credentialing and/or physician billing experience
Demonstrates accurate knowledge of payer credentialing guidelines
Experience in utilizing CAQH NPI and PECOS websites.
Excellent communication (verbal written) and organizational skills.
Able to work independently.
Attention to detail and accuracy is vital
Ability to work under pressure for a demanding clientele (physicians).
Excellent customer service skills.
Flexibility in order to assist or cover for other team members as required.
Required Education:
High School graduate.
Associates Degree preferred
Training / Certification / Licensures:
National Committee of Quality Assurance Certification (NCQA) preferred.
Required Experience:
IC
Employment Type
Full-Time
