Credentialing Coordinator in Dorchester, Massachusetts at Codman Square Health Center Inc

Codman Square Health Center is a Federally Qualified Health Center serving a diverse community in Dorchester, MA, and surrounding neighborhoods. CSHC offers a full continuum of services such as primary care, urgent care, behavioral health, care management, nutrition, family planning, optometry, dentistry, laboratory, pharmacy, radiology, and medical specialties including HIV care, substance use treatment, Hepatitis C, OB-GYN, Nephrology, and Cardiology alongside an on-site STI clinic.

CSHC is a teaching institution with academic affiliations at Boston University School of Medicine and Boston Medical Center, and a member of the Boston Accountable Care Organization. Our mission is to be our community's first choice for comprehensive, holistic, and integrated services, and to empower individuals to lead healthy lives and build thriving communities.

Position Summary:

The Credentialing and Enrollment Coordinator is responsible for ensuring that all Codman Provider files are up to date and maintained to meet compliance standards. The coordinator is responsible for timely responses to requests from privileging/enrollment partners for provider specific data.

Primary Responsibilities:

Provider Onboarding/Privileging

• Coordinates with medical staff hiring committee to document new medical staff hires.
• Collects contact information and submits data to privileging/appointment partner, Boston Medial Center (BMC).
• Provides provider new hires with “Welcome Onboarding Letter” which outlines process expectations, timelines, and points of contacts.
• Follows up with BMC to ensure that provider profile is set up and that application has been sent to provider for initial appointment.
• Serves as primary liaison between BMC and provider if BMC is unable to reach provider for application related requests via email.
• Monitors shared web tracking system for provider application updates and missing documentation.
• Informs medical staff committee when a provider has been approved by appointment board via report.

Insurance Enrollment

• Notifies enrollment partner, Credentialing Administrative Services (CAS) of new providers.
• Submits new providers data collection form.
• Collects documents required for provider enrollment and submits to CAS.
• Monitors enrollment progress.
• Notifies Provider, Medical Staff Committee and Human Resources when insurance enrollment threshold is met.
• Shares updates to CAS regarding provider termination.

General Responsibilities

• Acts independently to review and assess provider applications for completion, identifies credentialing concerns, and requests appropriate follow-up information from provider(s) or other sources as needed.
• Responsible for the quality and integrity of provider files. Ensure files are maintained according to and all applicable governing agencies and internal quality and security policies, to include both paper and electronic document management.
• Generates routine reports to assure timeliness of verifications, appropriate re-credentialing dates, and processing of expired documents.
• Processes approved reimbursement types for providers (i.e., certifications, membership dues, CME)
• Maintains insurance provider contract files.
• Identifies issues (lapses,etc) in the credentialing and enrollment process and escalates when necessary to ensure compliance.
• Works with BMC to enroll providers in prior authorization system.
• Serves as back up to COO’s executive assistant.

Benefits:

CSHC offers a generous benefits package including:

• Competitive Medical and Dental Insurance
• Employer-paid Life, Accidental Death & Dismemberment, and Long-Term Disability Insurance
• Retirement-403(b) plan
• Vacation, Holiday, Personal and Sick Time Accruals
• Flexible Spending Reimbursement Accounts (Health and Dependent Care)
• Educational Assistance and Tuition Reimbursement Programs
• Commuter Benefits
• Opportunities for academic appointment at Boston University / Boston Medical Center

Pay Range: $54,080.00 to $84,260.80 Annually. Compensation is commensurate with years of experience.

Qualifications & Skills:

• Strong time management, organizational skills, and detail-oriented with a commitment to quality.
• Ability to prioritize duties and meet deadlines for multiple clients.
• Highly organized.
• Interact professionally and effectively with all levels of staff, leadership, providers, and outside parties.
• Working knowledge of NCQA, Medicaid and other regulatory requirements.
• Excellent customer service skills.
• Knowledge of medical credentialing and privileging procedures and standards.
• Able to function independently and perform routine department procedures without supervision.
• Must have proven ability to maintain sensitive and confidential information.
• Strong written and verbal communication skills.