Credentialing Coordinator (Hybrid - Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
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.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.