Insurance Enrollment and Credentialing Coordinator - Credentialing

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

$20.10 - $26.13

Scheduled Weekly Hours:

40

Position Overview

Manages end-to-end credentialing and enrollment process, acting as a strategic liaison between providers, insurance entities and revenue cycle. Requires advanced analytical skills to evaluate complex documentation, ensure data integrity across many systems, and optimize the provider onboarding experience to safeguard group reimbursement.

MINIMUM REQUIREMENTS
Education:    High school diploma or equivalency.
Experience:    One year' provider credentialing and/or enrollment experience in a medical office environment. In leu of required experience, three years' Revenue Cycle experience in a healthcare setting specifically in contracting, billing, registration, or administration in a physician office or hospital.
Other Credentials:    
Knowledge and Skills:    Ability to communicate effectively and possess strong customer service skills. Excellent organizational skills, attention to detail and accuracy required. Ability to handle large volume of work, prioritize tasks and work efficiently under pressure
Special Training:    Proficiency in Windows based processing, excel spreadsheets & Credentialing software program. Knowledge or payer requirements relating to insurance credentialing and enrollment processing.
Mental, Behavioral and Emotional Abilities:    
Usual Work Day:    8 Hours  
Reporting Relationships
Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS
Maintains expert-level understanding of evolving accreditation and insurance regulations, performing regular audits of provider files to mitigate risk and prevent credentialing lapses.
Critically reviews and analyzes provider credentials, licenses, and certifications to ensure absolute compliance with state, federal, and payer-specific regulations.
Continuous training and research of processes and systems across 24 different payer platforms to ensure accuracy and efficiency in regard to regulations, policies, guidelines and procedures.
Updates health plans, agencies and other entities and systems to assure regulatory compliance with Federal and State mandates for current and accurate provider information.
Facilitates end-to-end enrollment lifecycle, strategically attaching providers to group billing entities to ensure uninterrupted reimbursement and optimized cash flow.
Analysis and completion of reports and data spreadsheets received from Payers. and other related applications to ensure timely revenue stream.
Identifying and resolving problems related to claim submission and denials, often working with Revenue Cycle Operations.
Manages complex project timelines for provider onboarding, utilizing advanced spreadsheet modeling and credentialing software to track milestones and resolve systemic deficiencies.
Completes timely follow-up of any CH provider enrollment issues by utilizing software system reporting. Maintains departmental logs and spreadsheets for updating all insurance credentialing and re-credentialing.
Maintains departmental logs and spreadsheets for updating all insurance credentialing and re-credentialing.
Acts as primary liaison between clinical providers, administrative leadership, and insurance representatives to expedite enrollment and resolve high-level billing discrepancies.
Clear and effective communication with insurance companies handling complex questions and issues dealing with day-to-day operations of credentialing and payer enrollment that can affect revenue.
Orchestrates accurate entry and maintenance of provider data across multiple systems and health plans to ensure organizational data integrity.
Assures insurance provider numbers are entered into billing system for claims submission as well as communication with CHMG administrators and managers.
Ability to manage multiple applications, track deadlines, and maintain organized records.
Performs other related duties as required or assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Sitting , Standing , Walking , Keyboard use/repetitive motion

Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities

Continuous physical demands include: Talk or Hear

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing
Anticipated Occupational Exposure Risks Include the following: N/A

IND123.

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.