Credentialing Coordinator - Health Alliance Plan - Detroit (Full - Time)
GENERAL SUMMARY:
Under minimal supervision, responsible for initial and re-credentialing functions including completion of the application and verification process, Credentialing Committee preparation and follow-up, coordination with contracting and interaction with practitioners, office staff and network representatives.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
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Responsible for all aspects of the CAQH credentialing application and verification process for initial and re-credentialing requests. Assess completeness of information and practitioner qualifications relative to regulatory standards and guidelines including NCQA, CMS, MDCH and HAP's established standards; maintain credentialing files according to regulatory standards and guidelines including NCQA, CMS MDCH, and HAP's standards.
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Assure all practitioner data is accurate and up-to-date in the CACTUS credentialing software application, including generating and monitoring reports.
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Responsible for on-going communication with internal and external customers. Respond to all correspondence within 48 hours. Consult with management quickly if unable to resolve within expected time frame.
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Coordinate, implement, analyze and close annual delegated audits, as assigned. As issues are identified, resolution must be documented and completed in a timely manner and in accordance with regulatory standards.
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Organize and maintain practitioner files following confidentiality guidelines.
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Extract and present key information including CAQH credentialing application and credentials, and identification of potential practitioner issues to facilitate the Credentials Committee decision-making process.
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Maintain tickler systems for follow-up of unanswered correspondence to maintain department standards for application processing time.
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Participate in all data integrity projects, as identified.
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Provide cross-coverage for other analysts, as needed.
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Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
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Associate’s degree in business, health care or related field or four (4) years of related experience in lieu of degree.
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Bachelor’s degree in business, health care or related field preferred.
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Two (2) years of experience in health care industry, managed care experience.
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Two (2) years of CACTUS physician credentialing software experience.
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Minimum of two (2) year experience in physician credentialing preferred.
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Knowledge of Council for Affordable Quality Healthcare (CAQH) Practitioner Application preferred.
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Ability to work under minimal supervision.
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Ability to perform detail work efficiently and with a high degree of accuracy.
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Excellent problem-solving skills.
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Highly organized.
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Ability to initiate and coordinate multiple projects simultaneously.
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Excellent verbal communication skills.
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Ability to interpret information and make judgments quickly.
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Ability to interact professionally with practitioners and other external customers.
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Strong quantitative and analytical skills.
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Computer proficient in Microsoft Office including; Word and Excel
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Knowledge of the principles and practices of credentialing is highly desirable.
CERTIFICATIONS/LICENSURES REQUIRED:
Certification as CPCS (Certified Provider Credentialing Specialist) or CMSC (Certified Medical Staff Coordinator) preferred.
Overview
Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health
care systems, is a national leader in clinical care, research and education. The system includes
the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health
insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory
network and many other health-related entities throughout southeast Michigan, providing a
full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care.
The health system also is a major economic driver in Michigan and employs more than 24,600
employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The
health system is led by President and CEO Wright Lassiter III. To learn more, visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.