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UnityPoint Health CVO Credentialing Coordinator in West Des Moines, Iowa

Responsible for performing credentialing activities to ensure UnityPoint Health has a provider network of the highest quality.

This position is responsible for timely processing and tracking of credentialing files, including primary source verification, review of information, and additional research as needed. This position shall serve as a liaison between providers, physician hospital organization (PHO), hospital medical staff offices and regulatory agencies.

Payer Enrollment and Database Accountability

  • Accountable to provide timely and accurate records for all provider information in the system of record

  • Responsible for the electronic initial and recredentialing, reappointment, and revalidation application processing.

  • Initiate and follow through on all aspects of provider credentialing including: initial and recredentialing process for all practitioners including performance of primary source verification in accordance with Medimore, Inc. policies and procedures, hospital medical staff bylaws and requirements, NCQA, URAQ, The Joint Commission, DNV, CMS and other regulatory agency guidelines.Responsible for the timely processing and tracking of credentialing files.

  • Coordinate with IT the creation and maintenance of provider payer panel records (EDI table) in Epic.

  • Responsible for responding to requests for provider credentialing information timely.

  • Review credentialing files for accuracy and completeness.

  • Monitor and assist further investigations as deemed necessary during the credentialing process by document evaluation, primary sources verifications, or as requested by UnityPoint Health stakeholders.

  • Develop, maintain and distribute reporting as required. .

  • Work with UnityPoint Health Medical Staff offices and physician practice administrative staff to support credentialing needs.

  • Identify and report any non-compliance or credentialing issues to the

  • Prepare initial credentialing and recredentialing files for the Medical Director of PHO and/or the Credentials Committee.

  • Prepare reappointment files for regional medical staff offices for the regional medical executive committees.

  • Establish a method for regular communication and respond to health professionals, provider representatives, or other essential departments the status of applications, the status in the credentialing process and the status of participation with health plans.

  • Enter and maintain accurate provider data in the organization credentialing database.

  • Maintain confidential credentialing files and electronic credentialing database.

  • Audit, correct and communicate to all appropiate parties, corrections of provider data in the credentialing database.

Onboarding of New Providers

  • Responsible for the collection of data to efficiently onboard new providers for payor enrollment, medical staff membership and/or privileges.

  • Coordinate with any and all UnityPoint Health customers to collect all data necessary for all payer applications and submissions, medical staff membership and/or privileges.

  • Open MSOW process for new providers within 5 days of receipt of application.

  • Enter all applicable information necessary for payer applications for new providers within 30 days of compleate applicaiton.

  • Regularly communicate with hospital medical staff offices to coordinate application packets for new providers.

Education:

  • High school graduate or GED equivalent.

  • Associates degree preferred.

Experience:

  • Minimum of 2 years of experience in the field of payer credentialing and enrollment, provider billing services, or health clinic customer service positions.

  • Knowledge of the managed healthcare industry.

  • Proficient in Microsoft Office Suite.

  • Knowledge of regulatory agency standards (i.e. NCQA, URAQ, The Joint Commission, etc)

  • Excellent communication skills both written and verbal.

  • Current experience with submission of payer applications.

  • Database experience

License(s)/Certification(s):

  • CPCS certified preferred

Knowledge/Skills/Abilities:

  • Highly organized

  • Excellent Interpersonal skills

  • Strong communication skills – written & verbal

  • Demonstrated ability to adapt to change

Requisition ID: 2020-83232

Street: 1776 West Lakes Pkwy

Name: HCF-Medimore

FTE (Numeric Only; Ex. 0.01): 1.0

FLSA Status: Non-Exempt

Scheduled Hours/Shift: Days, Monday - Friday

External Company URL: http://www.unitypoint.org

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