Provider Enrollment Credentialing Coordinator 1

Mercy Health Corporation

Rockford (IL)

On-site

USD 28,543 - 45,667

Full time

14 days+

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Benefits offered by this job

Medical benefits

Dental & Vision

Life Insurance

FSA/HSA

Paid time off

Parental leave

Tuition reimbursement

Well-being programs

Employee discounts

On-demand pay

Job summary

Mercyhealth in Rockford, IL seeks a Credentialing Specialist to manage physician credentialing across Medicare/Medicaid and other payers, obtain NPI numbers, and ensure timely billing readiness.

You will collaborate with Medical Staff Office, Clinic Directors, Clinic Finance, and recruiters, maintain CACTUS records, and drive re-credentialing before expirations.

Requires an Associate's degree or 5+ years credentialing experience; full-time onsite with competitive benefits.

Qualifications

Credentialing experience with Medicare/Medicaid and managed care payers is preferred.
Associate degree or 5+ years in credentialing or healthcare business support.
Three years' experience with Wisconsin/Illinois credentialing regulations is preferred.

Responsibilities

Maintain in-depth knowledge of credentialing requirements for providers across payers.
Obtain and assign NPI numbers for providers.
Collaborate with Medical Staff Office, Clinic Directors, and recruiters for timely credentialing.
Understand government forms and information needed for credentialing diverse providers.
Investigate or follow up on claims work queue as needed.
Maintain CACTUS data confidentiality and accuracy.

Skills

Mathematical Skills

Computer Skills

Language Skills

Reasoning Ability

Education

Associate degree

5+ years credentialing experience

Tools

CACTUS

Job description

ESSENTIAL DUTIES AND RESPONSIBILITIES

Understands and maintains an in depth knowledge regarding the requirements for credentialing physicians with Wisconsin and Illinois Medicare, Medicaid, Blue Cross and other third payers as necessary.
Responsible for implementing and obtaining NPI numbers per provider.
Works closely with the Medical Staff Office, Clinic Directors, Clinic Finance, Information Systems and physician recruiters to obtain necessary information on new physicians to complete the credentialing process, in a timely manner, necessary to get claims paid.
Understands the idiosyncrasies of the government forms, which forms are used and what information is necessary for credentialing physicians, physical therapists, CRNAs (Nurse Anesthetists), Physician Assistants, and residents.
Responsible for investigation or follow-up of claims work queue.
Understands facility enrollment as appropriate.
Utilizes a system, such as CACTUS, to house and maintain all credentialing information, to include, but not be limited to: when applications are submitted, when payer numbers were received, and what numbers have been assigned to each individual, by location and payer. Ensures confidentiality and accuracy of all credentialing information.
Utilizes the information in CACTUS to ensure the re‑credentialing process begins prior to any expiration of current statuses/numbers.
Obtains and maintains information necessary for credentialing Illinois physicians with each Mercy laboratory in Illinois with the Illinois Department of Public Aid. Processes information on a timely basis and monitors expiration dates.
As appropriate, is knowledgeable and completes forms/documents as necessary for obtaining provider numbers for Durable Medical Equipment (DME) by location. Monitors expiration dates and initiates the re‑certification process in a timely manner.
Responsible for ensuring that all the data maintained in CACTUS is current and that all personal information is kept confidential.
Responsible for communicating payer numbers received to a Patient Accounts Application Analyst to ensure the McKesson Plus system is current with the information necessary for timely billing of claims.
Provides reports as necessary for the Credentialing Committee, Patient Accounts, clinics, etc.
Facilitates communication within Mercy Health System on the credentialing process by being an active participant on the Credentialing Committee.
Develops, maintains, and implements policies and procedures necessary to support the credentialing process.
Responsible for educating partners in the application of the credentialing policies and procedures

EDUCATION AND/OR EXPERIENCE

Associate's degree and 1 year of healthcare credentialing/enrollment experience preferred (healthcare facility, managed care setting, CVO, medical staff office, or enrollment), or a minimum of 5 years of experience in credentialing (preferred), or a minimum of 5 years of experience in a healthcare business support area required. Three years' experience working with Wisconsin and Illinois Medicare and Medicaid credentialing regulations, plus managed care payers preferred.

CERTIFICATION/LICENSURE

N/A

OTHER SKILLS AND ABILITIES

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Computer Skills: To perform this job successfully, an individual should have knowledge of Patient Accounting software; Spreadsheet software and Word Processing software. CACTUS experience a plus.
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

LEVEL OF SUPERVISION

N/A

SUPERVISES

May supervise as designated by Director.

PAY RANGE

$20.72 - $33.15

EEO STATEMENT

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

BENEFITS