The Senior Provider Enrollment & Credentialing Coordinator provides analytical provider enrollment and credentialing functions with managed care plans, government payers and third-party vendors. Develops and maintains quality relationships with payer representatives and internal stakeholders, providing leadership and subject matter expertise. Conducts comprehensive payer roster reconciliations and quality assurance activities to maintain data integrity of internal and external platforms. Communicates participation information through established processes to allow for appropriate patient scheduling and reimbursement for services. Must be able to multitask and prioritize between projects to ensure no adverse impact to provider revenue and patient satisfaction.
Responsibilities
Manages the timely preparation, submission and tracking of delegated payer rosters, non-delegated payer applications and government enrollment materials for providers and groups.
Performs ongoing outreach and follow-up with managed care plans, government payers and third-party vendors.
Verifies loading and auditing of demographic/contractual data elements.
Prepares and distributes status updates to stakeholders for accurate and timely updating of databases, credentialing grids, dictionaries, portals and websites.
Serves as a key contributor to special credentialing, enrollment and operational projects, including large scale initiatives such as new payer/product roll-outs and centralization of additional enrollment and credentialing functions.
Utilizes v-lookup, pivot tables, concatenation and other Excel tools to complete compliance, reporting and quality assurance activities to maintain data integrity including comprehensive payer audits.
Serves as the primary point of contact for payers. Responsible for holding regular meetings to discuss enrollment, credentialing and linkage matters including identification of trends impacting multiple providers and groups. Prepares and distributes status reports and recommends resolutions to interested parties, escalating issues as appropriate.
Performs strategic and proactive tracking and follow-up as required to reduce denials associated with credentialing delays and discrepancies.
Works collaboratively with fellow team members to create and regularly evaluate the effectiveness of department Standard Operating Procedures. Makes recommendations for improvements and implements approved recommendations.
Identifies root causes for problems in provider enrollment workflow. Makes recommendations to address issues and implements approved recommendations.
Administers credentialing processes in accordance with NCQA guidelines, including quality assurance tasks, delegated credentialing payer audits and reporting and coordination of Credentialing Committees.
Implements and manages cross-functional projects, delegating tasks as deemed appropriate and asking for guidance when required.
Maintain familiarity and stay current with health insurance plans' procedures.
Performs other related duties as assigned within the scope of practice.
Minimum Qualifications
Bachelor's degree or equivalent in education and experience, plus a minimum of 3 years of related experience.
Exceptional analytical and problem solving skills with attention to detail and accuracy.
Advanced time management skills including planning, organization, multi-tasking, and ability to prioritize required.
Must demonstrate effective communication skills both verbally and written.
Specialized knowledge of managed care Credentialing/Enrollment.
Advanced knowledge of Microsoft Excel (e.g. vlookup, pivot tables, etc.) or similar software is required.
Preferred Qualifications
Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM) preferred.
Prior experience with IntelliCred, Cactus or similar credentialing system is preferred.
Prior experience at an academic medical center or health insurance plan is preferred.
Equal Opportunity Employer / Disability / Veteran
Columbia University is committed to the hiring of qualified local residents.
Internal Number: 508698
About Columbia University
Columbia University is one of the world's most important centers of research and at the same time a distinctive and distinguished learning environment for undergraduates and graduate students in many scholarly and professional fields. The University recognizes the importance of its location in New York City and seeks to link its research and teaching to the vast resources of a great metropolis. It seeks to attract a diverse and international faculty and student body, to support research and teaching on global issues, and to create academic relationships with many countries and regions. It expects all areas of the university to advance knowledge and learning at the highest level and to convey the products of its efforts to the world.
