LOCATION: Purchase, NY
WESTMED Practice Partners is currently recruiting for a full time Credentialing Coordinator.
The Credentialing Coordinator will primarily be responsible for the initiation and ongoing monitoring of provider applications/datasets with insurance carriers for WESTMED Medical Group (WMG) and the Rye Ambulatory Surgical Center (ASC). He/she will ensure that all new provider information is current, accurate and updated in credentialing applications/datasets. He/she will be responsible for trouble-shooting provider plan participation interruptions; routine database audits and clean-up; and complete special projects as assigned.
The credentialing process is a key component in certifying the overall privilege eligibility and quality of practice providers; and is necessary for initiating managed care payment.
Essential Job Functions & Responsibilities
· Initiate credentialing for new providers joining the group through the completion of managed care credentialing applications for which delegated credentialing contracts do not exist with WMG and/or the Rye ASC.
· Responsible for the initial linking and/or enrollment of WMG providers into NY Medicare and Medicaid, CT Medicare and Medicaid as well as NY/CT Rail Road Medicare, if applicable. Utilizing the MedicareProvider Enrollment, Chain and Ownership System (PECOS), and the Medicaid Electronic Provider Assisted Claim Entry System (ePACES), will initiate enrollment and apply for and obtain provider id numbers, acquire effective dates prior to employment, and maintain link to WMG.
· In a timely fashion, manages Medicaid enrollment re-verification of both WMG and the group’s incumbent Providers utilizing the Electronic Provider Assisted Claim Entry System (ePACES); as well as Medicare re-validations upon official notification from Medicare accordingly.
· Initiate and complete Workers’ Compensation enrollment for appropriate providers.
· Update and maintain provider information in the Council for Affordable Quality Healthcare (CAQH) database.
· In the event of absence or short-staffing, will assist the Credentialing Manager with initial or recredentialing projects.
· Responsible to responding to the Credentialing Department email inbox and telephone messaging system.
· Works closely with the Credentialing Associates to: obtain and maintain documents pertinent to provider files such as licenses, certifications, registrations, etc. for WMG and WESTMED Practice Partners (WPP) clients/providers including managing monthly expirables.
· Will work closely with Credentialing Department Manager on: initiating, reviewing and updating managed care provider rosters; trouble-shooting provider plan participation interruptions; routine database audits and clean-up; and special projects as assigned by the Credentialing Manager.
· Keeps the Credentialing Manager abreast of any roadblocks/delays and any adverse findings in a timely manner and/or as requested. Closely monitors information collected, assesses quality and adequacy of collected information, and pursues additional information as needed.
· In keeping with department policies, assures data security and confidentiality through the use of appropriate labeling of information, storage, and securing of all filing systems used to house Provider data.
· Is well versed on and appropriately utilizes all applications used to track Provider information: ECHO Credentialing Software, EKTRON, Centricity Business, MS Outlook and Sharepoint.
· Adheres to all WMG Compliance Program Policies and Procedures including all regulatory financial, HIPAA, and OSHA requirements. Participates in and contributes to help achieve a total compliance program.
- High School graduate.
- Two (2) years credentialing experience required
- Experience with credentialing database required
- Associate’s or Bachelor’s degree preferred
- CPCS certification preferred
Performance Standards for Specialty Knowledge, Skills & Abilities:
• Excellent computer skills.
• Excellent communication and organizational skills.
• Good interpersonal skills; ability to communicate with providers and office managers.
• Ability to work as a team member.
• Flexibility to respond to changing demands and environment.
• Ability to plan, prioritize and complete delegated demands.
Here at WESTMED Practice Partners, one of the most successful management services organizations in the United States health care community, we look for individuals who are interested in and seek a challenging, growth-oriented, dynamic and friendly environment. Individuals with a strong work ethic along with a caring personality are who we find to be most successful here, fitting into our not so basic mantra of simply being “Smart" & “Nice". Our organization is constantly looking to bring on like-minded people who have a genuine interest in helping people and possess an intellectual curiosity to try and do things better and more efficiently. We strive to bring out the best in all of our team members and provide individuals with the support they need to achieve their career aspirations.
WESTMED Practice Partners is a healthcare management services company that has evolved from the success of the WESTMED Medical Group, one of the largest multi-specialty medical groups in the country. In partnership with our clients, the mission of WESTMED Practice Partners is to improve the health of the communities we serve. We seek to grow the quality and efficiency of outpatient healthcare services by the design and management of free-standing, comprehensive medical offices with a focus on primary care. For more information, visit our web site at www.westmedpartners.com
We provide a modern office environment, state-of-the-art equipment and technology as well as competitive benefits and salary. Our benefits include medical, dental, free copays for employees who see WESTMED physicians, discounted vision glasses, life insurance, AD&D insurance, short-term and long-term disability, 401k and profit sharing, flexible spending plans, and more.
WESTMED Medical Group is considered the model for the future of healthcare. With over 350 physicians and over 900 staff, we are a high growth, financially thriving, multi-specialty group medical practice providing superior healthcare to patients and health information to the community. Our main office locations are located within Westchester County, New York and lower Fairfield County, Connecticut. Our offices provide full-service care, including primary and specialty care, radiology, lab services, and urgent care. The foundation for service excellence at WESTMED Medical Group starts with the patient experience and focusing on the complete total care of our patients. WESTMED is recognized by the National Committee for Quality Assurance as a Level 3 Medical Home, the highest achievable level. We are one of over 150 Medicare Accountable Care Organizations (ACOs) nationwide. WESTMED strives to be a "provider of choice" and an "employer of choice".
TO APPLY, CLICK HERE: https://careers-westmedgroup.icims.com/jobs/1293/credentialing-coordinator/job
Anne Tinsley, SHRM-CP
Senior Talent Partner/Physician Recruitment Lead
WESTMED Practice Partners
2700 Westchester Avenue
Purchase, NY 10577