Department:OH1CH_70517_000 MCHP Provider Credentialing
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we’re committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care
MediGold is a not-for-profit Medical Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
Job Description Details:
Our Credentialing Coordinator is responsible for implementation, monitor and appropriate documentation of all regulatory agency (i.e. ODHHS, ODM, OIG) etc. Administrative functions include: primary source verification of credentialing applications to include critical analysis of a provider's competence through assessment education and specific training. Serves as a credentialing liaison for Health Partners with all internal and external credentialing entities.
- Coordinates all office activities related to credentialing including processing of initial applications and reappointments for all participating physicians and allied health professionals. Responsible for validation, maintenance and updating credentialing and provider changes in credentialing database
- Tracks and reports on the status of all physician and AHP applicants in process on a weekly basis to ensure that credentialing functions are being performed in a timely manner and in accordance with MCHS needs and regulatory agency requirements.
- Performs coding quality audits and evaluates clinical documentation of provider charts. Manages National Sample RADV audits which includes coordination of internal and external deliverables.
- Education: High School diploma. Associate degree in administration, health or behavioral science field preferred.
- Licensure / Certification: CMSC or CPCS preferred (National Association of Medical Staff Services).
- Experience: Minimum of two years' experience in health related field performing credentialing activities.
- Must possess an in-depth knowledge of current Medicare coding and billing requirements. Must possess extensive knowledge of auditing concepts, principles and current medical terminology.
- Must possess strong written and verbal communication skills in order to communicate in clear, concise, terms to internal and external customers, including the ability to articulate complex regulatory information's in layman's terms.
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.