WellSpan Health Credentialing Coordinator - Centralized Verification Services - FT in York, Pennsylvania

Credentialing Coordinator - Centralized Verification Services - FT

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Job Description

General Summary:

Under general supervision, maintains close communication with providers, practice managers and the medical staff office to ensure timely initial credentialing, recredentialing and reappointments through the different entities, Credentials Committee and Board of Directors Meetings.

Duties and Responsibilities:

The following are essential job accountabilities:

Processes initial provider enrollment with payers, initial credentialing and recredentialing:

1 Creates, assembles and prepares application packet for providers to complete, reappointment applications for WellSpan Health entities and submits applications to payers.

2 Completes primary source verifying provider credentials per established policies and procedures.

3 Enters provider credentials and application requirements into Cactus, CAQH.

4 Initiates mandated queries, both federal and state, for all initial applicants and those due for recredentialing with the National Practitioner Data Bank.

5 Adheres to all policies and procedures regarding mandated queries and reporting mechanisms.

6 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.

7 Reviews and conducts QA checks on the applications prior to medical director’s review.

8 Reattests provider information every 120 days in CAQH.

9 Runs reports and complete Medicare and Medicaid revalidations for WellSpan Medical Group (WSMG) & Hospital Based providers.

10 Maintains confidentiality of provider information.

Data Management

11 Follows up, receives and documents confirmations on all initial enrollment status and changes for health plan providers with which WellSpan participates.

12 Runs weekly Credentialing Update reports to IS Department for billing system update.

13 Runs expiring provider credentials reports, notifies practices and updates Cactus accordingly.

14 Assists with helping resolve claim issues by contacting applicable provider reps.

Change letters

15 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.

Required Skills

Minimum Education

High School or G.E.D.

Preferred Education

Associate’s Degree

Minimum Experience

2 - 3 years

Pref Field Of Expertise

Hospital/physician office/insurance claims; credentialing experience

Pref Cert/Registration

National Association of Medical Staff Services (NAMSS) Certification as a Certified Provider Credentialing Specialist (CPCS)


Ability to multi-task, 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.

Job Location

York, Pennsylvania, United States

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