Credentialing Coordinator

Chambersburg, PA | Professional | Tracking Code: 75334

Job Description:

Under general supervision, maintains close communication with providers, practice managers and the medical staff office to ensure timely initial credentialing, recredentialing and reappointments through the different entities, Credentials Committee and Board of Directors Meetings.

 

Duties and Responsibilities

Essential Accountabilities:

  1. Processes initial provider enrollment with payers, initial credentialing and recredentialing:
  2. Creates, assembles and prepares application packet for providers to complete, reappointment applications for WellSpan Health entities and submits applications to payers.
  3. Completes primary source verifying provider credentials per established policies and procedures.
  4. Enters provider credentials and application requirements into Cactus, CAQH.
  5. Initiates mandated queries, both federal and state, for all initial applicants and those due for recredentialing with the National Practitioner Data Bank.
  6. Adheres to all policies and procedures regarding mandated queries and reporting mechanisms.
  7. Maintains close communication with provider, practice managers, medical staff office, insurance reps, locum tenens agencies, office administrators to ensure timely credentialing through the different entities.
  8. Reviews and conducts QA checks on the applications prior to medical director’s review.
  9. Reattests provider information every 120 days in CAQH.
  10. Runs reports and complete Medicare and Medicaid revalidations for WellSpan Medical Group (WSMG) & Hospital Based providers.
  11. Maintains confidentiality of provider information.
  12. Data Management
  13. Follows up, receives and documents confirmations on all initial enrollment status and changes for health plan providers with which WellSpan participates.
  14. Runs weekly Credentialing Update reports to IS Department for billing system update.
  15. Runs expiring provider credentials reports, notifies practices and updates Cactus accordingly.
  16. Assists with helping resolve claim issues by contacting applicable provider reps.
  17. Change letters
  18. Creates and submits letters to update payers, Cactus, CAQH, NPI and other stakeholders of any changes and terms to provider data per 25 payer requirements.
 

 

Qualifications

  • Notes:
    • Other combinations of formal education, training and experience may be considered.
  • Minimum Experience:
    • 2 - 3 years
  • Minimum Education:
    • High School or G.E.D.
  • Preferred Education:
    • Associate’s Degree
  • Preferred Field Of Expertise:
    • Hospital/physician office/insurance claims; credentialing experience
  • Required Certification:
    • National Association of Medical Staff Services (NAMSS) Certification as a Certified Provider Credentialing Specialist (CPCS)
  • Physical Demands:
    • Mostly sedentary work
    • Occasional prolonged standing/walking
  • Skills:
    • Ability to multi-task, work independently by prioritizing work load, high level of organizational skills, proficiency in data entry, ability to handle interruptions such as phone calls, emails and meetings. Excellent computer skills; excellent communication/interpersonal skills.

Fraud Notice: Please be aware of potentially fraudulent job postings on other websites or suspicious recruiting email or text messages that attempt to collect your confidential information. If you are concerned that an offer of employment with WellSpan Health might be a scam, please verify by searching for the job posting on joinwellspan.org or contact us at employment@wellspan.org.

Michael Hasircoglu
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Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises a multispecialty medical group of more than 1,600 physicians and advanced practice providers, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 20,000 employees and 200 patient care locations. WellSpan is a charitable, mission-driven organization committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts

Diversity & Inclusion

Welcome. Respect. Value.

Wellspan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected, and valued while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

Quality of Life

Franklin County, named after Benjamin Franklin, was officially formed in 1784. One of its two main towns, the borough of Chambersburg, lies 13 miles north of Maryland, and is known for its "green, safe environment." In the southern part of Franklin County, the borough of Waynesboro sits just two miles north of the Mason-Dixon Line and is known for its rich industrial history.

Franklin County is in the heart of South-Central Pennsylvania where you'll find mountains, lakes, and a picturesque countryside coupled with theater, music, skiing, hunting, fishing, and much more. We're in the heart of America's fruit orchards, so peaches, apples, and lots of other local produce are available close by. The area features local wineries and breweries, along with a vibrant arts scene at the historic Capitol Theatre and Totem Pole Playhouse. Franklin County merges the best of small-town friendliness with easy access to metropolitan areas. (Patient population: 154,000)