Managed Care Credentialing Coordinator, Mid-Level

Jobright.ai

Milwaukee (WI)

On-site

USD 55,000 - 60,000

Full time

14 days+

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Benefits offered by this job

Medical insurance

Vision insurance

401(k)

Job summary

A healthcare provider in Milwaukee is seeking a Managed Care Credentialing Coordinator to oversee the enrollment of providers with commercial payers. The candidate will collaborate with various departments while managing the credentialing process, requiring excellent communication and organizational skills. A minimum of four years in an administrative support role with advanced proficiency in Microsoft Office is essential for success in this full-time position.

Qualifications

Four years’ experience in administrative support position including database management.
Proven track record of effective interactions with physicians and health care professionals.
Ability to manage multiple priorities effectively and independently.

Responsibilities

Manage enrollment of providers with commercial payers.
Collaborate with various departments on credentialing processes.
Maintain communication regarding credentialing and enrollment activities.

Skills

Excellent communication

Organizational skills

Problem solving

Advanced Microsoft Office proficiency

Database management

Education

Four years of administrative support experience

Tools

Microsoft Excel

Microsoft Access

Microsoft PowerPoint

Credentialing software

Job description

Managed Care Credentialing Coordinator, Mid-Level

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Managed Care Credentialing Coordinator, Mid-Level

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Job Summary:

Aurora Health Care is seeking a Managed Care Credentialing Coordinator to facilitate the enrollment of providers with commercial payers. The role involves managing the enrollment process, collaborating with various departments, and maintaining communication regarding credentialing and enrollment activities.

Responsibilities:

• Manages enrollment of all employed and contracted AAMG providers by applying subject matter expertise skills based on specific hiring/contractual arrangements to decide appropriate credentialing variables, demographics and service line.

• Participate and/or request meetings with key contacts in AAMG to sort out appropriate credentialing route and enrollment processing of providers hired/contracted under a unique arrangement/contract. Collaborating with multiple departments/areas to streamline the above processes.

• Adheres to deadlines and scheduled managed care credentialing committees by tracking files through all stages. Day-to-day responsibility for maintaining proactive communication with internal and external individuals regarding credentialing, enrollment and government payor activation processes.

• Oversee receipt/review and processing of all practitioner demographic/specialty/other changes and resignation requests to be delivered to APP Network Management team for processing and distribution to commercial payers.

• Communicate regularly via phone, fax, or written correspondence with Credentials Verification Office, Hospital medical staff offices, contract entities, physicians and group practice offices. Provide direct support to Managed Care Credentialing coordinators in the processing of verifications and database maintenance of credentialing elements for new applicants and reapplicants. Also in tracking timely submission of recredentialing applications from AAMG.

• Data entry and record keeping of ancillary practitioners employed by AAMG. Track expirables of licensure, insurance and board certification for all AAMG practitioners credentialed members of APP.

• Respond to internal/external questions and resolutions of problems relative to delayed, incomplete or problematic matters, specific to credentialing and provider enrollment according to established policies/procedures.

• Represent team in medical group AAMG Acquisitions team, AAH Payer Activation, Advocate Intensivists and Office of APC weekly meetings.

Qualifications:

Required:

• Four (4) years’ experience in administrative support position including database management.

• Excellent communication, organizational and problem solving skills

• Advanced Proficiency in the use of Microsoft Office (Excel, Access, PowerPoint and Word) and credentialing software

• Knowledge of accrediting and regulatory agencies as related to the Medical Staff, including (but not limited to) Joint Commission, DNV, HFAP, CMS, OSHA, NCQA and State and Federal Law and other standards and regulations, and hospital and system-wide policies regarding licensed independent practitioners in the hospital setting required.

• Must have proven track record of effective interactions with physicians and other health care professionals

• Ability to work effectively and independently.

• Demonstrated ability to effectively manage multiple priorities

Company:

At Aurora Health Care, helping people live well is what drives us – it’s our purpose and what we do every day. Founded in 1984, the company is headquartered in Milwaukee, Wisconsin, USA, with a team of 10001+ employees. The company is currently Late Stage.

Seniority level