Provider Enrollment & Credentialing Coordinator

Details

Posted: 22-Feb-24

Location: New York, New York

Type: Full-time

Salary: Open

Categories:

Staff/Administrative

Internal Number: 542029

• Job Type: Officer of Administration
• Bargaining Unit:
• Regular/Temporary: Regular
• End Date if Temporary:
• Hours Per Week: 35
• Standard Work Schedule: M-F
• Building: Fort Lee, NJ
• Salary Range: 62000-67000

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting.
 

Position Summary

The Provider Enrollment & Credentialing Coordinator performs provider enrollment and credentialing functions to support the ColumbiaDoctors Credentialing Program, data maintenance activities, and payer enrollments.

Responsibilities

Technical

• Work closely with key internal and external stakeholders to complete comprehensive audits of credentialing, demographic, and participation data, performing timely corrections as deficiencies are identified.
• Receive, review, analyze, and process a high volume of credentialing and enrollment requests for delegated, non-delegated, government, and third-party payers and vendors.
• Provide timely feedback on data/documents utilizing standard checklists and reports. Identify and escalate critical incomplete items and issues, highlighting important deadlines.
• Maintain current and valid credentials, documents, forms, and applications in collaboration with internal and external stakeholders, in accordance with Standard Operating Procedures. 
• Perform data entry and document imports to maintain provider profiles and track application/credentialing/enrollment status.
• Conduct timely and consistent follow-up, escalating if no response, insufficient feedback, or unacceptable response.
• Log, troubleshoot, and track enrollment, credentialing, contractual, fee schedule, and demographic payer and provider issues. Clearly identify the action needed and responsible party(s) and communicate follow-up in a consistent manner.
• Participate in departmental and payer meetings with internal and external stakeholders, documenting discussions and follow-up items.
• Conduct proactive and timely internal and external verification initiatives and roster audits.
• Verify credentials by searching third-party databases, determining the validity of data and documents received, and accepting/rejecting information accordingly.
• Assess and reprioritize work in accordance with shifting priorities and backlog in conjunction with the supervisor.
• Assist with credentialing, enrollment, and operational projects and reporting as needed.
• Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures.
• Establish and maintain positive relationships with providers, practices, and payers.
• Works collaboratively with fellow team members to regularly evaluate the effectiveness of department Standard Operating Procedures and workflows and identify gaps.  Provides feedback and recommendations to the supervisor for improvements. Implements approved changes.

Compliance and Other

• Perform related duties as assigned within the scope of practice.
• Represents PEG on committees, task forces, and work groups as assigned. 
• Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.

Minimum Qualifications

• Bachelor???s degree or equivalent in education and experience.
• Must demonstrate strong analytical and problem-solving skills with attention to detail and accuracy.
• Strong time management skills including planning, organization, multi-tasking, and ability to prioritize required.
• Must demonstrate effective communication skills both verbally and written.
• Demonstrated proficiency in Microsoft Office (Word & Excel) or similar software.
• Must be a motivated individual with a positive and exceptional work ethic.
• Must successfully complete systems training requirements.
• Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.

Preferred Qualifications

• Specialized knowledge of managed care credentialing/enrollment is preferred.
• Prior experience at an academic medical center or health insurance plan is preferred.
• Prior experience with IntelliCred, Cactus or a similar credentialing system is preferred.
• Intermediate knowledge of Microsoft Excel (e.g. vlookup, pivot tables, etc.) or similar software is preferred.

Competencies

Patient Facing Competencies	Minimum Proficiency Level
Accountability & Self-Management	Level 2 - Basic
Adaptability to Change & Learning Agility	Level 2 - Basic
Communication	Level 2 - Basic
Customer Service & Patient-Centered	Level 3 - Intermediate
Emotional Intelligence	Level 2 - Basic
Problem Solving & Decision Making	Level 3 - Intermediate
Productivity & Time Management	Level 3 - Intermediate
Teamwork & Collaboration	Level 2 - Basic
Quality, Patient & Workplace Safety	Level 2 - Basic
Leadership Competencies	Minimum Proficiency Level
Performance Management	Level 1 - Introductory

Equal Opportunity Employer / Disability / Veteran

Columbia University is committed to the hiring of qualified local residents.

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About Columbia University
Columbia University is one of the world's most important centers of research and at the same time a distinctive and distinguished learning environment for undergraduates and graduate students in many scholarly and professional fields. The University recognizes the importance of its location in New York City and seeks to link its research and teaching to the vast resources of a great metropolis. It seeks to attract a diverse and international faculty and student body, to support research and teaching on global issues, and to create academic relationships with many countries and regions. It expects all areas of the university to advance knowledge and learning at the highest level and to convey the products of its efforts to the world.
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