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Job Description
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The Provider Credentialing Coordinator is responsible for facilitating SelectHealthxe2x80x99 s credential verification program and practitioner database. At the facility level, this position will serve as the primary credentialing coordinator. At the Corporate level the position will provide centralized support to liaison for hospitals, practitioners, and/or insurance providers regarding credentialing services.
This position also facilitates the development and execution of contracts under the supervision of the credentialing/contracting supervisor. These responsibilities include the drafting, implementation, tracking, and updating of participating provider contracts for SelectHealth and maintaining appropriate records of these activities. This position contributes to the oversight and management of provider contracts for SelectHealth and serves as a liaison between SelectHealth and affiliated providers
Monday xe2x80x93 Friday Flexible schedule with 8 hours daily work any hours you want! Remote/Hybrid or in office available
Job Essentials Credentialing
1. Facilitates all aspects of credential verification program with accuracy and attention to detail including CAQH.
2. Creates and maintains practitioner files. Receives initial appointment applications, assures completeness and verifies credentials as outlined on the application to include: Education and training, Peer references, Hospital affiliations, State licensures (including controlled substance licenses) and DEA. Queries the National Practitioner Data Bank. Also collects other pertinent information requested for Intermountain Healthcare.
3. Coordinates reappointment dates for all practitioners participating in the credential verification program. Assures completeness and verifies reappointment credentials, query hospital affiliations to verify continued competence, current state licensure (including controlled substance DEA certification), current malpractice coverage and claims history. Queries the National Practitioner Database.
4. Prepares credentials summary and assembles reappointment packets for each facility to which the practitioner is applying or reapplying including SelectHealth for review and approval by the Director of Medical Staff Services.
5. Gains and maintains a working knowledge of current CMS/NCQA standards as well as state and federal guidelines and requirements.
6. Serves as the primary liaison between practitioners, dealing with issues, questions, assessing needs and meeting expectations. Makes sure facilities and/or Insurance Providers follow through on initial appointments and reappointments in a timely manner. Has frequent contact with system wide medical staff services professionals, administrators and/or medical directors, and practitioners.
7. Keeps the Credentialing/Contracting Managers apprised of problems or concerns and assists in the preparation of reports, handle correspondence, arrange meetings, etc.
Job Essentials Contracting:
1. Serves as primary contact and resource to provider offices for all participating provider service agreement contracts. Coordinates and manages the contracting process for all participating providers including the development, amendment, and termination of contracts. Assists providers in resolving contract-related issues. Advises provider offices and other SelectHealth colleagues of regulatory and policy requirements related to contracting and the contracting process.
2. Develops contracts, amendments, and extensions using approved templates. Drafts language to address unique situations/concerns for review by Manager or Director. Assures proposed contract changes are appropriately reviewed and approved.
3. Coordinates across SelectHealth and Intermountain teams when a contract involves multiple organizational units while maintaining respect for confidential information including recruitment and credentialing information.
4. Maintains awareness of the legal and operational ramifications that changes to contract language may have to the contract, other provisions in the specific contract or in the implementation of the contract to assure changes do not negatively impact other aspects of the contract. Maintains a broad understanding of provider contract agreements.
Minimum Qualifications
Associate degree. Education must be obtained through an accredited institution. Degree will be verified.
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Four years of contracting experience with Intermountain Healthcare or SelectHealth.
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One year of professional work experience in the areas of contract development, contract management, or healthcare operations support.
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Demonstrated ability to establish and maintain effective working relationships with colleagues, administrators, Medical Staff personnel, corporate personnel, and physicians.
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Experience using word processing, spreadsheet, database, internet and e-mail, and scheduling applications.
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Experience in a role requiring effective verbal, written, and interpersonal communication skills.
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Experience in a role requiring the ability to organize and prioritize multiple projects and to meet deadlines.
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Experience in a role requiring the demonstration of attention to detail, specifically as it relates to written communication in the areas of grammar, spelling, proof reading, and punctuation.
Preferred Qualifications
Associate degree that includes coursework in the areas of accounting, finance, business law, and contract development. -and-
Knowledge of Salesforce Physical Requirements: Manual Dexterity, Seeing Location: SelectHealth – Murray Work City: Murray Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $22.84 – $34.78 We care about your well-being xe2x80x93 mind, body, and spirit xe2x80x93 which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers , and for our Colorado, Montana, and Kansas based caregivers our commitment to diversity, equity, and inclusion .
