WellSpan Health

Credentialing Coordinator Senior - Centralized Verification Services - Day

Location: WellSpan Health, York, PA

Schedule: Full Time

Sign-On Bonus Eligible

Remote/Hybrid

Regular

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General Summary

Takes a lead role in maintaining close communication with providers, practice managers and the medical staff office to ensure timely initial credentialing of providers. Responsible for managing files that are sent to South Central Preferred's Credentials Committee and Board of Directors Meetings. The role include serving as a subject matter expert and providing training to junior staff members.

Duties and Responsibilities

Essential Functions:

• Processes initial provider enrollment with payers, initial credentialing and recredentialing: - Creates, assembles and prepares application packet for providers to complete, reappointment applications for WellSpan Health entities and submits applications to payers. - Completes primary source verifying provider credentials per established policies and procedures. - Enters provider credentials and application requirements into Cactus, CAQH. - Initiates mandated queries, both federal and state, for all initial applicants and those due for recredentialing with the National Practitioner Data Bank. - Adheres to all policies and procedures regarding mandated queries and reporting mechanisms. - Maintains close communication with provider, practice managers, medical staff office, insurance reps, locum tenens agencies, office administrators to ensure timely credentialing through the different entities. - Reviews and conducts QA checks on the applications prior to medical director's review. - Prepares and presents providers to monthly credentials committee and board meetings. - Maintains confidentiality of provider information.

• Data Management - Follows up, receives and documents confirmations on all initial enrollment status and changes for health plan providers with which WellSpan participates. - Reviews & submits multiple monthly delegated spreadsheets & invoices to multiple payers for WSMG & community providers. - Assists with helping resolve claim issues by contacting applicable provider reps.

• Change letters - Creates and submits letters to update payers, Cactus, CAQH, NPI and other stakeholders of any changes and terms to provider data per 25 payer requirements. - Processes group changes resulting from new WellSpan mergers and acquisitions. - Serves as a resource and trainer.

Common Expectations:

• Maintains established policies and procedures, objectives, quality assessment and safety standards.

• Maintains professional growth and development.

• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• High School Diploma or GED Required

• Associates Degree Preferred

Work Experience:

• 5 years Relevant experience. Required

• Hospital/physician office/insurance claims or credentialing experience. Preferred

Licenses:

• Certified Provider Credentialing Specialist Upon Hire Preferred

Knowledge, Skills, and Abilities:

• Ability to multi-task and work independently by prioritizing work load.

• High level of organizational skills.

• Proficiency in data entry.

• Ability to handle interruptions such as phone calls, emails and meetings.

• Excellent computer skills.

• Excellent communication/interpersonal skills.

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You’re unique and you belong here.

At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email atemployment@wellspan.org. We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.