Contracting and Credentialing Coordinator – Full-Time – Billing Department

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*Northern California Medical Associates is an Equal Opportunity Employer


Position Title: Contract and Credentialing Coordinator
Clinic: Billing Department
Location: Santa Rosa, CA
Schedule: Full-Time, Monday – Friday

Summary: Monitors and maintains contracting and credentialing information/activities for the group. Assists in gathering physician data for contracting and credentialing purposes. Prepares and communicates new enrollment or demographic changes to the health plans. Monitors expirables. Assists in research of various topics as needed. Assists with reports.

Duties and Responsibilities (includes, but is not limited to the following):
• Prepare, submit and follow up on paper or online applications to health plans and letters informing health plans of demographic changes.
• Enroll and maintain provider and location information with Medicare via PECOS online portal and with Medi-Cal via PAVE online portal.
• Monitor CMS revalidation cycle for providers and office locations and take appropriate action to complete.
• Enter and maintain information in credentialing database; demographic information on CAQH, NPPES, Better Doctor and other sites as identified.
• Monitor expiration dates of all expirables including medical licenses, Driver’s Licenses, board certifications, DEAs, CLIAs, state laboratory permits, and TB tests.
• Prepare, submit and follow up on all renewals.
• Complete hospital appointment and re-appointment applications.
• Obtain signed summary from provider, as needed, for any reportable matter relating to credentialing.
• Coordinate with office personnel regarding timely completion of needed documents and signatures.
• Notify management and appropriate office personnel of contracting and hospital appointment status.
• Assist with questions from billing or office staff regarding contract status.
• Maintain scanned and paper credentialing files.
• Submit all applications and demographic changes within expected time frames.
• Research various topics as needed.
• Assist in preparing reports and/or with special projects.
• Attend meetings as requested.
• Participate in educational activities.
• Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.
• Other duties as assigned.
• Regular and reliable attendance is required to perform the functions of this position.

Supervisory
• This position has no direct supervisory responsibilities.

Education, Licensure and/or Certifications
Required
• High school diploma or GED.

Experience
• One year of billing or contracting/credentialing experience in a health care organization. Additional appropriate education may be substituted for one year of billing experience.

Knowledge, Skills and Abilities
• Knowledge and understanding of billing practices.
• Knowledge and understanding of office policies and procedures.
• Knowledge and understanding of Medicare, Medi-Cal and health plan fee schedules and reimbursement policies.
• Knowledge and understanding of billing to Medicare, Medi-Cal and health plans.
• Basic knowledge of CPT, ICD-10, and HCPCS coding.
• Extensive knowledge of Microsoft Word, Excel and Outlook. Knowledge of Microsoft Access helpful.
• Skill in using computer, adding machine, and other office equipment.
• Excellent oral and written communication skills.
• Ability to prepare documents in accordance with detailed instructions.
• Ability to examine documents for accuracy and completeness.
• Ability to work effectively with physicians, co-workers, patients, and outside parties..

Physical Demands: The physical demands described here are representative of those that may need to be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Requires prolonged sitting, some bending, stretching and occasional lifting of up to 25 pounds.
• Requires use of the telephone.
• Requires manual dexterity to operate keyboard, calculator, copy machine and other office equipment.
• Requires eyesight correctable to 20/20 to read numbers, letters and computer monitor.
• Requires hearing within normal range for telephone use.

Work Environment: The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work is performed in an office environment and may involve frequent contact with staff, physicians and/or insurance companies. Occasional evening or weekend work may be requested.