Provider Enrollment Credentialing Coordinator

Provider Enrollment Credentialing Coordinator 1

Mercyhealth Wisconsin and Illinois

Mercyhealth Trauma Center;
Janesville, WI. Hybrid work schedule opportunity available after training period.

• Responsible for the coordination of the provider credentialing activities within the Department of Patient Accounts, to include being the organizational resource for government/third party payer credentialing regulations, and in maintaining systems which are consistent with current industry standards.
• 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.

• Associate’s degree AND 1 year of experience in a healthcare-related environment, preferably in credentialing/provider enrollment; OR minimum 3 years of experience in a healthcare-related environment required, preferably in credentialing/enrollment.

• 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.

• Comprehensive Benefits Package:
  Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.
• Competitive Compensation:
  Mercyhealth offers market…