Provider Enrollment Credentialing Coordinator 1 - Janesville

Overview:

• Provider Enrollment Credentialing Coordinator, Medical Staff Office, Days, 80 Hrs / 2 wks
• Location: Mercyhealth Trauma Center; Janesville, WI. Hybrid work schedule opportunity avaliable after training period.

As appropriate, responsible for the application process for provider numbers for Durable Medical Equipment (DME) and for obtaining the appropriate laboratory numbers by physician for Illinois Department of Public Aid. Performs other duties as assigned.

Responsibilities:

• Understands and maintains an in depth knowledge regarding the requirements for credentialing physicians with Wisconsin and Illinois Medicare, Medicaid, Blue Cross and other third payers as necessary.
• Responsible for implementing and obtaining NPI numbers per provider.
• Works closely with the Medical Staff Office, Clinic Directors, Clinic Finance, Information Systems and physician recruiters to obtain necessary information on new physicians to complete the credentialing process, in a timely manner, necessary to get claims paid.
• Understands the idiosyncrasies of the government forms, which forms are used and what information is necessary for credentialing physicians, physical therapists, CRNAs (Nurse Anesthetists), Physician Assistants, and residents.
• Responsible for investigation or follow-up of claims work que.
• Understands facility enrollment as appropriate.
• Utilizes a system, such as CACTUS, to house and maintain all credentialing information, to include, but not be limited to: when applications are submitted, when payer numbers were received, and what numbers have been assigned to each individual, by location and payer. Ensures confidentiality and accuracy of all credentialing information.
• Utilizes the information in Cactus to ensure the re-credentialing process begins prior to any expiration of current statuses numbers.
• Obtains and maintains information necessary for credentialing Illinois physicians with each Mercy laboratory in Illinois with the Illinois Department of Public Aid. Processes information on a timely basis and monitors expiration dates.
• As appropriate, is knowledgeable and completes forms documents as necessary for obtaining provider numbers for Durable Medical Equipment (DME) by location. Monitors expiration dates and initiates the re-certification process in a timely manner.
• Responsible for ensuring that all the data maintained in Cactus is current and that all personal information is kept confidential.
• Responsible for communicating payer numbers received to a Patient Accounts Application Analyst to ensure the McKesson Plus system is current with the information necessary for timely billing of claims.
• Provides reports as necessary for the Credentialing Committee, Patient Accounts, clinics, etc.
• Facilitates communication within Mercy Health System on the credentialing process by being an active participant on the Credentialing Committee.
• Develops, maintains, and implements policies and procedures necessary to support the credentialing process.
• Responsible for educating partners in the application of the credentialing policies and procedures

Culture of Excellence Behavior Expectations

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to others views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

Education and Experience

OR minimum 3 years of experience in a healthcare-related environment required, preferably in credentialing enrollment.

Certification and Licensure

Associates degree and 1 year of healthcare credentialing enrollment experience preferred (healthcare facility, managed care setting, CVO, medical staff office, or enrollment), or a minimum of 5 years of experience in credentialing (preferred), or a minimum of 5 years of experience in a healthcare business support area required.

Three years experience working with Wisconsin and Illinois Medicare and Medicaid credentialing regulations, plus managed care payers preferred.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Computer Skills

To perform this job successfully, an individual should have knowledge of Patient Accounting software; Spreadsheet software and Word Processing software. CACTUS experience a plus.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Special Physical Demands

The employee must occasionally lift and or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.

Level of Supervision

NA

Supervises

May supervise as designated by Director.