Contracting and Credentialing Coordinator

Benefits include:

• Monday - Friday (No weekends and no holidays)


• Health, dental, and vision full coverage for individual - Family option available


• Short term/long term disability options


• Vacation (annual) + PTO (accrued weekly)


• 16 paid holiday closures in the calendar year


• 401K - 5% matching


• Parental, medical, education, bereavement leaves and so much more!
  

BASIC FUNCTION:

The Contract & Credentialing Coordinator is responsible for all aspects of the credentialing, re-credentialing and privileging processes for all employee and consultant practitioners that deliver patient care at the Seneca Nation Health System (SNHS). Responsible for ensuring that all licensed and credentialed providers meet acceptable qualification standards to provide care within the scope of services outlined by their respective job description. This position maintains current knowledge of credentialing and privileging processes and compiles relevant documentation into individualized credentialing files for review and approval. This position is also responsible for maintaining a schedule and keeping track of employee and consultant contracts. Will track the expiration of certifications to maintain up-to-date files.

GENERAL RESPONSIBILITIES:

1. Coordinates the timely credentialing, re-credentialing and privileging of new and current Physicians, Dentists, Licensed Independent Practitioners and Advanced Practice Professionals following National Committee for Quality Assurance (NCQA) standards.


2. Performs Primary Source Verifications of practitioner information in compliance with NCQA and CMS standards.


3. Enters, maintains and updates practitioner information into the electronic credentialing software in an accurate and timely manner.


4. Maintains a current knowledge of the Medical Staff Bylaws, Rules & Regulations and Credentialing policies.


5. Monitors practitioners due for re-credentialing and confirm they are re-credentialed timely.


6. Completes and maintains current and accurate data for all employee and consultant practitioners.
   
   
   
   1. Contacts hospitals and/or appropriate agencies for the purpose of verifying information such as, National Practitioner Data Bank (NPDB), New York State Office of the Professions, New York State Department of Health Office of Professional Medical Conduct, Drug Enforcement Agency (DEA) Verification Licensure, Professional Education verification, Board Certification Training verification, Residency/Fellowship training verification, and Peer Recommendation/References
   
   
   
   


7. Prepares and communicates correspondence to practitioners regarding the outcome of their application and re-credentialing review.


8. Maintains knowledge of accrediting bodies’ requirements and recommend best practices.


9. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all practitioners.


10. Tracks expiration dates of all state licenses, DEA certificates, malpractice coverage and contracts.


11. Provides credentialing and privileging verifications.


12. Performs timely reviews of disciplinary action reports issued by State licensure bodies, Medicaid, and other agencies as appropriate. Escalates issues or concerns appropriately to the Chief Medical Officer.


13. Keeps track of annually required provider CEU’s; allowance/usage.


14. Maintains health system practitioners contract files, schedule and notifies Human Resource personnel of rate increases.


15. Maintains a schedule of consultant hours and the amount paid to each.


16. Upholds and promotes the value and integrity of the Seneca Nation Health System’s mission statement. Will promote SNHS in a positive manner.


17. Provides team collaboration through a trauma-informed lens by incorporating key principles of both physical and psychological environment safety, trustworthiness and transparency, collaboration of decision-making during departmental plan developments, empowerment of co-workers by recognizing and building upon individual strengths, as well as recognizing and respecting the diversity of cultural backgrounds and sensitivity.


18. Maintains a detailed log of practitioner administrative times used for the annual Medicare and Medical cost report


19. Maintains confidentiality of all practitioner information.


20. Attends all mandatory staff meetings, trainings and in-services.


21. Follows all department, SNHS, and Seneca Nation policies.

KNOWLEDGE, SKILLS, & ABILITIES:

• Experience with data entry and a working knowledge of Windows, Microsoft Word, Excel, and Outlook


• Self-starter with the ability to work independently and as an effective team member


• Strong verbal and written communication skills and professional demeanor are highly essential


• Must have the ability to manage competing priorities


• Knowledge of medical credentialing and privileging procedures and standards

QUALIFICATIONS:

• Associate’s Degree with a minimum of three years’ office experience in a healthcare setting.


• NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred, or equivalent with intent to pursue NAMSS or CPMSM within first year of accepting position.


• Minimum of 2 years of credentialing experience with hospital medical staff or equivalent preferred.


• Experience in a large hospital, academic medical center, outpatient health care setting, or Indian Health Service (IHS)/tribal health, preferred.