Payor Credentialing Coordinator

Job Description:

Blue Sky Neurology – Englewood, CO

Blue Sky Neurology (BSN) is an innovative neurology practice that provides the full spectrum of neurologic services for patients and those involved in their care. BSN has physicians involved in all phases of neurologic illness: acute neurologic emergencies; neurologic support for hospitalized patients; and outpatient care for those with new or ongoing neurological conditions. BSN was founded in 2005 by established clinicians known throughout Denver and the Colorado region.

BSN provides acute stroke care; neuro-critical care; neurologic support and outreach throughout Colorado and the surrounding states with telemedicine technology to hospitals and emergency rooms. There is also active participation in national clinical research studies on the latest neurological treatments. In order to bridge hospital care to outpatient care, BSN has dedicated outpatient neurologists who all have advanced fellowship training and expertise. BSN has office staff, administration, and management to encompass the full spectrum of patient needs and customer service. We are dedicated to providing excellent and compassionate patient care.

The philosophy by which we practice blends a caring approach with forward thinking, up-to-date knowledge of neurologic disorders and treatments.

Qualifications:
In order to perform this job successfully, individuals must be able to meet and perform each essential duty in a satisfactory manner. The requirements below are representative of the knowledge, skill, ability and/or experience required. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

  • High school diploma or equivalent.
  • Two years of relevant credentialing experience.
  • Attention to detail is a must.
  • Ability to learn new software quickly and efficiently.
  • Must be organized, with the ability to track many different items at once. Essential Duties and Responsibilities include the following. Other duties may be assigned if determined in the best interest of the Practice.

 

  • Responsible for all aspects of the credentialing, re-credentialing and privileging processes for diagnostic imaging centers and physicians. Responsible for ensuring providers credentialing is current with private and public payers (Medicare & Medicaid). Maintain up-to-date data for each provider in credentialing databases and systems; ensure timely renewal of licenses and certifications.
  • Organize and implement credentialing information using a software database.
  • Track all equipment information and assure that all certifications are in place for all centers.
  • Manage licenses and other required information for radiologists and technologists.
  • Manage the Medicare 855B applications for all centers, updating with new information as it comes up and becoming main point of contact for all correspondence.
  • Work closely with contracting specialist to provide all needed documentation
  • Develop a strong understanding of the IDTF rules and requirements.
  • Compiles and maintains current and accurate data for all providers
  • Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
  • Maintains corporate provider contract files
  • Maintains knowledge of current health plan and agency requirements for credentialing providers
  • Sets up and maintains provider information in online credentialing databases and system
  • Tracks license and certification expiration for all providers to ensure timely renewals
  • Ensures practice addresses are current with health plans, agencies and other entities
  • Processes applications for appointment and reappointment of privileges
  • Audits health plan directories for current and accurate provider information
  • Other- Compliance, HIPAA and Security
  • Employees acknowledge that compliance with CarePoint’s HIPAA, Security and Compliance Plan policies and procedures as well as all other CarePoint policies and procedures is a condition of employment and that any violation will result in sanctions up to and including termination based on the type and severity of the violation.
  • Access to and use of Protected Health Information – security clearance which allows employees to review, investigate, and respond to questions from payors.
  • Security access permitted using the Practice entrances for this job category is during core hours of building management, 5 days a week.

Job Type: Full-time

Required experience:

  • relevant credentialing experience: 2 years