Credentialing Coordinator (Hybrid - Troy, MI) - Health Alliance Plan
GENERAL SUMMARY:
Under minimal supervision, responsible for initial and re-credentialing functions including completion of the application and verification process, Credentialing Committee preparation and follow-up, coordination with contracting and interaction with practitioners, office staff and network representatives.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Responsible for all aspects of the CAQH credentialing application and verification process for initial and re-credentialing requests. Assess completeness of information and practitioner qualifications relative to regulatory standards and guidelines including NCQA, CMS, MDCH and HAP's established standards; maintain credentialing files according to regulatory standards and guidelines including NCQA, CMS MDCH, and HAP's standards.
- Assure all practitioner data is accurate and up-to-date in the CACTUS/symplr Provider credentialing software application, including generating and monitoring reports.
- Responsible for on-going communication with internal and external customers. Respond to all correspondence within 48 hours. Consult with management quickly if unable to resolve within expected timeframe.
- Coordinate, implement, analyze and close annual delegated audits, as assigned. As issues are identified, resolution must be documented and completed in a timely manner and in accordance with regulatory standards.
- Organize and maintain practitioner files following confidentiality guidelines.
- Extract and present key information including CAQH credentialing application and credentials, and identification of potential practitioner issues to facilitate the Credentials Committee decision-making process.
- Maintain tickler systems for follow-up of unanswered correspondence to maintain department standards for application processing time.
- Participate in all data integrity projects, as identified.
- Provide cross-coverage for other analysts, as needed.
- Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Associate’s degree in business, health care or related field or four (4) years of related experience in healthcare industry, managed care experience in lieu of degree.
- Bachelor’s degree in business, health care or related field preferred.
- Minimum of two (2) years of experience in managed care experience.
- Minimum of two (2) years of experience in physician credentialing.
- Minimum of two (2) years of CACTUS/symplr Provider physician credentialing software experience preferred.
- Knowledge of Council for Affordable Quality Healthcare (CAQH) Practitioner Application preferred.
- Ability to work under minimal supervision.
- Ability to perform detail work efficiently and with a high degree of accuracy.
- Excellent problem-solving skills.
- Highly organized.
- Ability to initiate and coordinate multiple projects simultaneously.
- Excellent verbal communication skills.
- Ability to interpret information and make judgments quickly.
- Ability to interact professionally with practitioners and other external customers.
- Strong quantitative and analytical skills.
- Computer proficient in Microsoft Office including; Word and Excel
- Knowledge of the principles and practices of credentialing is highly desirable.
CERTIFICATIONS/LICENSURES REQUIRED:
- Certification as CPCS (Certified Provider Credentialing Specialist) or CMSC (Certified Medical Staff Coordinator) preferred.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.