Provider Enrollment Credentialing Representative
Location:
Coppell , Texas
Posted:
October 19, 2017
Reference:
26824-138778
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.

As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.

Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.

JOB DESCRIPTION

JOB TITLE: Provider Enrollment Credentialing Representative

GENERAL SUMMARY OF DUTIES: This position will initiate and carry out the day-to-day operations of the credentialing department, which include performing activities related to the credentialing of all providers in an Urgent Care setting. The structure of this position will change with the growth of the organization

SUPERVISOR: Director of AR

SUPERVISES: NIA

DUTIES INCLUDE BUT ARE NOT LIMITED TO:
• Work closely with the Credentialing Coordinator to ensure all necessary paperwork is timely and accurate
• Provide technical and administrative support for the Credentialing Processing Center including
o Completion of the standardized credentialing applications and provider forms for initial and reappointment cycles
o Contact and assist providers with information needed to complete credentialing process
o Process required primary source verifications and sanctions for providers according to AAAHC and NCQA standards
o Enrollment with malpractice insurance carrier and obtain previous certificates of insurance and claims histories
o Prepare and organize credentialing file
o Obtain proper signatures when necessary
o Prepare meeting minutes, approval letters, and privileging documents
• Research, review, and articulate missing/missed components to complete state specific credentialing requirements
• Communicate continually with physician and medical staff offices following up on outstanding information
• Communicate roster changes
• Enter new hires in practice management system
• Maintain provider dynamic credentialing
o Follow up with providers for license/certification renewals prior to expiration
• Maintain and complete any documentation received for work comp networks and managed care networks
• Complete malpractice requests for current and former providers regarding malpractice certificates and loss claims letters
• Maintain and respond daily to email and phone inquiries from internal and external departments
• Performs duties in accordance with defined policies and procedures and meets departmental Service Level Agreements associated with their area of responsibility
• Provides excellent Customer services to all external and internal customers
• Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement"
• Other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES
• Customer Service, written and communication skills
• Knowledge of Credentialing requirements from the state, AAAHC and NCQA
• Strong problem solving and analytical skills
• Ability to prioritize and organize multiple tasks
• Strong attention to detail
• Skills in technology such as MS Office Excel, Word
• Ability to maintain confidentiality, work efficiently in a team environment with Physicians, APP's leadership, clinical staff and all employees of the division

EDUCATION
• High School Diploma (Required)
• Associates Degree (Preferred)

EXPERIENCE
• Minimum 2 year experience in payer enrollment/credentialing required for commercial and work comp payers

CERTIFICATION/LICENSE: NIA

PHYSICAL DEMANDS/WORKING CONDITIONS: Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.

A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom

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