Provider Enrollment Coordinator

Department/Unit:

Medical Staff Credentialing

Work Shift:

Day (United States of America)

Salary Range:

$47,921.64 - $71,882.46Evaluates, analyzes, and coordinates all aspects of the Medical Staff and Delegated Credentialing and Recredentialing processes for practitioners practicing within the Albany Med Health System & its affiliates. Will serve as a liaison between internal clients and functional department including Albany Med Health System's ongoing auditing & monitoring of credentials files. The Provider Enrollment Specialist Serves as a high functioning member of the team working independently on a closing the caseload for providers and assists with the NCQA payor and delegation audits and routine monitoring on an ongoing and annual basis. This position will assist with NCQA and Payor QA audits and the communication to the Payors as outlined by regulations and the Integrated Delivery System (IDS) Manual and will have a role in the Quality Analysis (QA) review of charts. This position is responsible for a portion of the expirable process and ensuring compliance with timely notices to providers. Review and complete enrollment and re-enrollment applications, including subsequent roster changes, with delegated and/or individual contracts for all billing providers under the AMHS umbrella and affiliate Tax Identification Numbers.

Essential Duties and Responsibilities

• Participates in System wide Credentialing Committee
• Participates in Medical Staff Credentialing Committee
• Actively participates in planning and improving application Process Metric and sharing the QA data with the Payors as outlined by the Delegated contracts
• Distribute billing notifications for new or termed providers, provider demographic, and all location updates to all key stakeholders
• Provide coordination with AMHS MCPG Office on governmental payor applications between all members of the IDS/CVO
• Ensure through audits that the Albany Med Health System's programs are consistently administered in compliance with Albany Med Health System and organizational policies and procedures, delegation and contractual obligations, rulings, laws, and government regulations
• Assists with onboarding and training of new credentialing associates to the NCQA and provider enrollment process
• Expertise with NCQA Credentialing Standards, Compliance
• Familiarity with Managed Care Health Insurance Plans, credentialing, and enrollment
• Works with the Director and members of the MSO/CVO on the Payor enrollment process to ensure smooth onboarding of providers to the AMHS IDS system.
• Works with the CVO staff to ensure the rosters are generated and sent out in a timely manner to allow the delegated provider to begin billing immediately at the date of effective credentialing.

Qualifications

• Associate's Degree in Business Administration or related field - required
• Bachelor's Degree in Business Administration or related field - preferred
• 1-3 years in Credentialing Verification Office and/or Payer credentialing - required
• 1-3 years in Medical Staff, and/or Managed Care credentialing - required
• Proficiency in MSOW, Cactus, Credential Stream or other credentialing software database
• Strong interpersonal, communication, organizational skills (extensive work and collaboration with other organizations)
• Ability to work effectively and cooperatively with both internal and external individuals, departments, and agencies
• Identifies problems, gathers data, establishes facts, and draws valid conclusions.
• Knowledge of TJC requirements in conjunction with credentialing principles
• Ensures compliance with the accrediting agencies (i.e., NCQA, JCAHO, NYS DOH, NYS DOE, CMS and Federal laws)
• Certified Provider Credentialing Specialist (CPCS) Upon Hire - preferred

Equivalent combination of relevant education and experience may be substituted as appropriate.

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Balancing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Crawling - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently

Working Conditions

• Extreme cold - Rarely
• Extreme heat - Rarely
• Humidity - Rarely
• Wet - Rarely
• Noise - Occasionally
• Hazards - Rarely
• Temperature Change - Rarely
• Atmospheric Conditions - Rarely
• Vibration - Rarely

Thank you for your interest in Albany Medical Center!​

Albany Medical is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.