Employment Type:

Shift:

Description:

Job Title:

Senior Payer Credentialing Coordinator

Employment Type:

Full-Time

Shift:

Days

(SUMMARY) Position Highlights:

Competitive pay

Additional Benefits: tuition reimbursement free parking employee discounts

Quality of Life:Flexible work schedules

Advancement:professional growth within the organization

Location:Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore MD.

Description:

Monday-Friday

The Senior Payer Credentialing Coordinator contributes to the overall success of the department by independently developing relationships with insurance payers and physicians across multiple service lines and departments. This position will support all comprehensive processes for credentialing and recredentialing for both new and existing physicians and practices including employed and contracted for over 24 service lines.

Responsibilities:

Utilize independent judgement and oversee the operations of the payer credentialing processes for all hospital-based providers physician office providers health center providers and employed specialist providers.

Develop and maintain processes monitor procedures develop and oversee complex audits and manage credentialing issues from payers support credentialing re-credentialing privileging and delegated credentialing contract processes

Responsible for ensuring that billing and follow-up activities are performed promptly and in an accurate manner to assist in order to reduce potential financial loss to the patient and the Ministry Organization.

Creates and maintains the database of providers (Physicians and Mid-level; Employed and Contracted) for credentialing and re-credentialing upon hire and contract date.

Mentor revenue specialists charge specialists and other team members related to payer credentialing best practices.

Serves as the implementation coordinator for the Medical Staff Office for the Web (MSOW) software go-live and systems point person for all payer credentialing updates and process reviews as well Epic credentialing super user

Maintains a working knowledge of applicable Federal State and local laws and regulations Trinity Healths Organizational Integrity Program Standards of Conduct as well as other policies and procedures in order to ensure adherence in a manner that reflects honest ethical and professional behavior.

Supplies accurate and timely provider roster to Managed Care payers

Manages monthly meetings with payers and gives report on changes (i.e. Amerigroup Maryland Physicians Care).

Oversees the operations of the payer credentialing processes for all hospital-based providers physician office providers health center providers and employed specialist providers.

Participate as lead contact for complex Federal audits Trinity audits and internal audits driving positive and outstanding results.

Tracks licensure and certification expirations for all providers to ensure timely renewals via reporting tools.

Verifies with insurance company provider eligibility. Documents all transactions of the provider application process.

Reports to the Director of Professional & Ambulatory Revenue Services

What you will need:

Bachelors Degree in related field Masters degree preferred.

7-10 years work experience including minimum 4 years experience in the Credentialing or Health Care industry.

Certified Professional Credentialing Specialist (CPCS) required

Working knowledge of medical terminology anatomy and physiology medical record coding (International Classification of Diseases ICD-10 Current Procedural Terminology CPT Healthcare Common Procedure Coding System HCPCS).

Ability to critically analyze and apply standards to information submitted by the providers.

Detail oriented and highly organized.

Proficiency in Outlook Word and Excel.

Excellent written and oral communication skills.

Knowledgeable on HIPAA/Confidentiality guidelines.

Able to manage the pressures associated with setting priorities handling a large workload and managing workflow. Able to successfully work in a transparent environment.

Other duties and responsibilities as deemed necessary according to business needs.

The incumbent must have a thorough knowledge of various insurance documentation requirements the patient accounting system and various data entry codes to ensure proper service documentation and billing of the patients account.

Pay Range $26.42 - $36.99

Pay is based on experience skills and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

About us:

Holy Cross Health is a Catholic not-for-profit health system that serves more than 240000 individuals each year from Marylands two largest counties Montgomery and Prince Georges counties. Holy Cross Health earns numerous national awards clinical designations and accreditations across a wide range of specialties for providing innovative high-quality health care services.

We were named one of Americas 100 Best Hospitals for 2021.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status

Our Commitment

Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability veteran status or any other status protected by federal state or local law.