Provider Credentialing Coordinator

J  o  b    D  e  s  c  r  i  p  t  i  o  n

Job Information

Title:

Provider Credentialing Coordinator

Market Range:

MR14

Approved Date:

3/10/2021 1:31:06 PM

FLSA:

Non-Exempt

EEO Code:

PROFESSIONALS

Career Level:

C3

Career Level Description:

Core Services Level 3

Job Code:

100765

Job Family:

Fiscal and Business Management

Sub Family:

Business Management

Primary Purpose

The Provider Credentialing Coordinator serves as coordinator for completing and maintaining agency and provider credentialing and attestations which includes the Local Health Department and Pharmacy.  The job ensures interpretation and compliance with the appropriate accrediting and regulatory agencies while developing and maintaining a working knowledge of the statutes and laws relating to credentialing.

•

Completes agency and provider enrollment submissions for reimbursement of all payors. Meets with new hire Physicians and Mid-level practitioners to complete provider enrollments necessary for Wake County Human Services to bill claims to payers for services rendered in Public Health clinics and pharmacies.

1

55%

•

Monitors the initial, reappointment, and expireables process for practitioners, ensuring compliance with regulatory bodies, bylaws, policies/procedures, and delegated agreements.

2

15%

•

Sets up and maintains billable provider tables and information in Centricity Software system along with user administration functions in NCTracks, NCID, and NCIR portals.

3

10%

•

Works directly or independently with counterparts at commercial insurance companies and Medicaid to understand proper corrective actions to rebill and reprocess provider claim denials. Researches denials due to provider enrollment.

4

10%

•

Performs weekly and monthly internal provider enrollment file audit reviews, commercial insurance roster reviews,  insurance carrier enrollment updates, and system status updates for corrective action needed to prevent provider denials.

5

10%

Position(s) may perform other duties in addition to the above as assigned by management.

*IMPORTANT* In the event of an emergency, as determined by the County Manager or designee, participation in preparedness and response operations should be expected. Employee may be required to fill a temporary assignment in a role different from standard duties, work hours and/or work location in preparation for, during and after the emergency. Employee may also be required to participate in relevant exercises and regular preparedness training.

Career Level Dimensions

Career Level:

C3

Career Level Description:

Core Services Level 3

•

Works to deliver day-to-day objectives that directly impact the achievement of results for the Work Group.

•

Work consists of tasks that are typically not routine.

•

Works independently under limited supervision, applying discretion when required.

•

Responsible for recommending adjustments to processes or systems that improve the effectiveness of the Work Group.

•

May be required to apply discretion within broad operational boundaries and procedures.

•

Communicates within and outside Work Group to obtain information or explain practices and policies.

•

Responsible for providing, guidance, coaching, and training to lower-level support employees.

•

Requires broad knowledge of operational systems and practices typically gained through extensive experience, technical training, and/or advanced education.

Qualifications

•

Bachelor's degree

•

No specific experience required

•

Equivalent education and experience are accepted

•

3 Years

Experience in Credentialing Providers in a Healthcare setting

•

Certified Provider Credentialing Specialist (CPCS)

•

Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet resources

•

Ability to establish and maintain effective working relationships with associates, officials and the public

•

Superior customer service skills, integrity, and commitment to collaboration and forward-thinking efficiency

•

Excellent oral and written communication skills. 

•

Excellent PC skills with proficiency in MS Office products. 

•

Ability to work independently in carrying out oral and written instructions

•

Knowledge of Provider Enrollment Practices as it related to Medical Billing and 3rd Part Medical Office Billing

An individual must be able to perform each essential duty satisfactorily to perform this job successfully. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Competencies

Attention to Detail

Thoroughness in accomplishing a task through concern for all the areas involved, no matter how small. Monitors and checks work or information and plans and organizes time and resources efficiently.

Communication

Creates an atmosphere in which timely and high-quality information flows smoothly up and down, inside and outside of the organization; encourages open expression of ideas and opinions.

Reliability

Demonstrates a high level of dependability in all aspects of the job.

Reading Comprehension

Grasps the meaning of written information, and applies it to work situations.

Customer Service

Balances interests of a variety of clients, and readily readjusts priorities to respond effectively to pressing and changing demands for information, advice and assistance.  Anticipates and meets the needs of clients; achieves quality end products; and commits to continuous improvement of services.

Consulting

Applies knowledge of policies and procedures in the area of work to advise others across the organization on critical issues.

Integrity

Act with honesty, transparency and respect in our interactions with co-workers and those we serve. Adhere, without exception, to laws, policies, procedures and professional standards.

Accountability

Establish high-quality standards for work. Add value. Measure results and hold self and others accountable for making progress toward desired outcomes. Take a logical and data-driven approach to decision-making.

Diversity

Believe that different backgrounds and experiences strengthen the organization and produce better results. Value inclusion across race, gender, age, religion, identity and experience, and strive to reflect in our workforce the diversity of our community.

Collaboration

Foster a work culture in which different ideas and opinions are encouraged and expected. Listen carefully and speak thoughtfully. Work together toward shared goals with mutual respect and cooperation.

Continuous Improvement

Continuously improve work processes and products. Provide a safe environment to be innovative and creative and try new things. When things don't go as planned, use it as an opportunity to learn, regroup and begin again. Provide time and resources for individuals to grow and develop both personally and professionally.

Wellness

Take proactive steps to be physically fit and healthy, emotionally strong, financially secure and socially fulfilled, while inspiring and empowering others to do the same.

Service Orientation

Commit to making a difference within the community. Actively engage in and enjoy our work. Deliver services that exceed expectations, with courtesy, politeness and sensitivity to the experiences, concerns and feelings of all co-workers and customers.

ADA Checklist

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Standard ADA Selection:

Office Environment

Standing

X

Walking

X

Sitting

X

Lifting/Carrying 0-10 pounds

X

Lifting/Carrying 10-20 pounds

X

Lifting/Carrying 20-50 pounds

X

Lifting/Carrying 50-100 pounds

X

Pushing

X

Pulling

X

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Handling

X

Grasping

X

Fingering

X

Feeling

X

Talking

X

Hearing

X

Visual Perception

X

Repetitive Motions

X

Eye/Hand/Foot Coordination

X

Memorization/Concentration

X

Learning/Knowledge Retention

X

Preparing/Analyzing Numerical Figures

X

Use of Interfaced Commmunication Devices (Phone, Computer, Radio etc.)

X

Analyzing/Examining/Testing Data

X

Emotional/Behavioral Self-Regulation

X

Interacting with Others

X

Comprehension

X

Organization

X

Decision Making

X

Comprehension

Understand and apply non-routine verbal and/or written instructions

Organization

Organize and prioritize individual work schedule to manage multiple tasks and/or projects

Decision Making

Make decisions that have an impact on the immediate work unit's operations and/or services

Communication

Communicate and explain a variety of information

Extreme cold

X

Extreme heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Computers/Monitors

X