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General Summary

Maintains close communication with providers, practice managers and the medical staff office to ensure timely initial credentialing, recredentialing and reappointments through the different entities, Credentials Committee and Board of Directors Meetings.

Duties and Responsibilities

Essential Functions:

+ Processes initial provider enrollment with payers, initial credentialing and recredentialing: - Creates, assembles and prepares application packet for providers to complete, reappointment applications for WellSpan Health entities and submits applications to payers. - Completes primary source verifying provider credentials per established policies and procedures. - Enters provider credentials and application requirements into Cactus, CAQH. - Initiates mandated queries, both federal and state, for all initial applicants and those due for recredentialing with the National Practitioner Data Bank. - Adheres to all policies and procedures regarding mandated queries and reporting mechanisms. - Maintains close communication with provider, practice managers, medical staff office, insurance reps, locum tenens agencies, office administrators to ensure timely credentialing through the different entities. - Reviews and conducts QA checks on the applications prior to medical director's review. - Reattests provider information every 120 days in CAQH. - Runs reports and complete Medicare and Medicaid revalidations for WellSpan Medical Group (WSMG) & Hospital Based providers. - Maintains confidentiality of provider information.

+ Data Management - Follows up, receives and documents confirmations on all initial enrollment status and changes for health plan providers with which WellSpan participates. - Runs weekly Credentialing Update reports to IS Department for billing system update. - Runs expiring provider credentials reports, notifies practices and updates Cactus accordingly. - Assists with helping resolve claim issues by contacting applicable provider reps.

+ Change letters - Creates and submits letters to update payers, Cactus, CAQH, NPI and other stakeholders of any changes and terms to provider data per 25 payer requirements.

Common Expectations:

+ Maintains established policies and procedures, objectives, quality assessment and safety standards.

+ Maintains professional growth and development.

+ Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

+ High School Diploma or GED Required

+ Associates Degree Preferred

Work Experience:

+ 2 years Relevant experience. Required

+ Hospital/physician office/insurance claims or credentialing experience. Preferred

Licenses:

+ Certified Provider Credentialing Specialist Upon Hire Preferred

Knowledge, Skills, and Abilities:

+ Ability to multi-task and work independently by prioritizing work load.

+ High level of organizational skills.

+ Proficiency in data entry.

+ Ability to handle interruptions such as phone calls, emails and meetings.

+ Excellent computer skills.

+ Excellent communication/interpersonal skills.

Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more - within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.