Sr Credentialing Coordinator

REMOTE WORK OPPORTUNITY - This position can work in Omaha or Kearney or Remote in Nebraska

*Nebraska Resident only*

ESSENTIAL KEY JOB RESPONSIBILITIES

● Manage an assigned territory of providers, completing all commercial delegated credentialing requirements, collection of all government enrollment materials to ensure meeting the targeted employment effective date; Requires on-going monitoring to meet effective dates, to avoid claim revenue losses, referral/preauthorization’s issues, and requires continual communication with operations and new providers.
● Compile and authenticate Commercial Payer and Government Enrollment, Medical Staff, Allied Health applications and waiver requests in compliance with payer and regulatory requirements and accreditation standards. This includes but is not limited to, the primary source verification of information, collection and analysis of information received, and the pursuit of additional information as necessary.
● Analyze essential data within the applications and all additional relevant
documentation/information to ensure compliance with payer, NCQA, URAC, federal and state
regulatory requirements, Medical Staff bylaws and affiliated documents, and TJC standards for initial appointment, reappointment in an independent, efficient and timely manner. Must be
able to manage a high volume of provider files, while maintaining completion prior to targeted effective dates and ability to deal with multiple tasks and interruptions with minimal supervision.

● Provider/clinic liaison, fielding questions re: effective dates, credentialing requirements,
privileging requirements. Follows file all the way through completion of payer credentialing and facility privileges if applicable. Must understand strategies of how clinics are set up, tax id#s,
group NPI#s, in order to set up successful payer enrollment profiles of providers to ensure
appropriate collection on claims revenue.
● Serve as team lead by organization and delegating workload management for credentialing coordinators, responsible for management of the reappointment process and delegation of
reappointments to ensure timely completion of credentialing files. Prepare/audit secondary
review of team files, per NCQA and payer standards, creating team educational opportunities for learning.
● Responsible for meeting management including agenda development, appropriate
documentation and follow-up on key issues. Direct, educate and motivate Medical Directors and physician leaders to accomplish their assigned tasks either with matters of significance to
department business or in support of the credentialing program and serve as the technical
resource regarding NCQA/URAC/CMS standards and adherence to delegated policies and procedures governing the credentialing staff.
● Serve as backup for procedures and processes currently conducted by the Director to include assisting with annual delegated commercial payer audits, generating approval letters and payer enrollment reports, and serving as the technical expert for the credentialing software program and technical NCQA/URAC/CMS and state and federal requirements.
● Responsible for protection of highly confidential and sensitive information including peer review and HIPAA protected information.

Required Education and Experience:

High School Diploma/GED Two (2) years of health-care related physician/allied health professionals credentialing experience, medical staff related experience or degree in Business Administration or medical staff services in management, in lieu of experience.

Preferred Education and Experience:

Associates Degree or Bachelors Degree Successful experience with previous delegated commercial payer audits.

Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities.

CHI Health provides you with the same level of care you provide for others. We care about our employees’ well-being and offer benefits that complement work/life balance.

With you in mind, we offer the following benefits to support your work/life balance:

• Health/Dental/Vision Insurance 
• Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
• Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care
• Voluntary Protection: Group Accident, Critical Illness, and Identity Theft 
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO) 
• Tuition Assistance for career growth and development
• Matching 401(k) and 457(b) Retirement Programs
• Adoption Assistance
• Wellness Programs
• Flexible spending accounts

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.