Credentialing Coordinator

Job Type
Full-time
Description
Panorama Orthopedics & Spine Center has been a trusted provider of orthopedic care in metro Denver for more than 70 years. Though we have grown over time, our values have remained the same. Our group of more than 40 orthopedic surgeons is one of the largest orthopedic groups in the United States. Here we are committed to quality, teamwork, and accountability.
Panorama provides a competitive total compensation package, including a full benefits package and a Profit-Sharing plan. Beyond compensation, we provide an environment where you will find yourself surrounded by great people dedicated to helping patients and supporting each other. We make a difference in the lives of others by helping them Do More and Feel Better.
Responsibilities

• For all Panorama physicians, ensure continuity of Board Certifications, state licensure, Drug Enforcement Agency (DEA) certificate, Continuing Medical Education (CME) units, Purified Protein Derivative (PPD) tuberculosis test, National Provider ID (NPI) number, and data in Council for Affordable Quality Healthcare (CAQH) credentialing database, by requesting information from physicians and site managers and tracking and following up on responses.
• For all Panorama Physician Assistant (PA) and Nurse Practitioner (NP) staff, notify, track and follow up on required updates to ensure continuity of licensure, DEA, NPI, disclosure forms, job descriptions and PA Policy.
• For all therapists and nursing personnel within Panorama, ensure continuity of licensure and disclosure forms by notifying, tracking and following up on required updates.
• For all contract therapists and reading radiologists, ensure continuity of all licensure and malpractice certificates by notifying, tracking and following up on required updates.
• Work with Risk Management and Insurance Department as well as Human Resources Department as required to ensure issues related to above items are coordinated and well communicated.
• Actively participate in provider recruitment efforts, including background checks and queries, scheduling of interviews, and planning and organizing applicable portion of the New Physician Orientation Program.
• Maintain accuracy of Medicare and Medicaid provider numbers.
• Provide timely submission of required materials for all physicians who require hospital privileges.

Independently manages all activities related to provider credentialing and recredentialing, according to the policies, practices, procedures, philosophy, compliance guidelines, objectives and mission of Panorama. These responsibilities include, but are not limited to the following:

• Update Systems Department with changes in expirations and/or new license and DEA information.
• Manage timely and thorough credentialing and recredentialing for all Panorama providers.
• Ensure that all locations and facilities are added, as appropriate and obtain and maintain NPI facility numbers for all locations.
• Maintain strong working relationships with provider relations/credentialing personnel at health plans and hospitals.
• Using termination checklist, manage applicable portion of termination process when providers leave Resurgens.
• Ensure that each new physician is assigned a mentor.
• Actively participate in New Physician Orientation Team meetings and relevant activities.
• Ensure that new physician performance evaluations are completed in timely manner and distributed to appropriate parties.
• Attend Board Meetings and other relevant meetings as requested.
• Perform new and ad hoc tasks as assigned.

Requirements

• Associates degree preferred; minimum three years of related experience or an equivalent combination of education and experience. Knowledge of and experience in health care environment, with specific experience in a physician group and/or health plan preferred.

Ability to:

• Read, analyze and interpret payer/health plan website information, Centers for Medicare and Medicaid Services (CMS) website information and bulletins, CAQH database elements, relevant portions of managed care contracts.
• Respond clearly and concisely to routine inquiries from internal and external contacts and to seek guidance from Director of Revenue Management in unusual or exceptional circumstances.
• Develop and effectively present information to management team, Panorama's Board of Directors, and other audiences as required.
• Ability to define problems, collect data, establish facts and draw valid conclusions utilizing professional judgment.
• Strong interpersonal/communication skills required in order to work effectively with staff, physicians, other providers, physician candidates, and external contacts. Willingness to work "hands on" and independently, and to adapt to a rapidly changing environment.
• Ability to work constructively and harmoniously with staff, co-workers, physicians and other providers, as well as outside contacts.
• Demonstration of excellent process management skills and ability to determine and effectively manage priorities.

Panorama Orthopedics & Spine Center is an Equal Opportunity Employer, Male/Female/Veteran/Disabled. Offers of employment are contingent upon successful completion of a pre-employment drug screen and background check.
Salary Description
$56k to $73K