VMG Credentialing Coordinator

Job Summary:

Coordinates all VMG clinicians’ compliance of information with the CAQH (Council for Affordable Quality Healthcare) and PECOS (Provider Enrollment Chain and Ownership System) databases to ensure accurate clinician information is in the CAQH and PECOS system, such as but not limited to documents, affiliations, hours of operations, and call coverage partners. If data is not accurate, the coordinator will be responsible to update and attest appropriately to ensure timely recredentialing. Collects and analyzes information thoroughly to identify potential quality of items for processing to perform the attestation of the information timely and accurately.  Works directly with the payers for verification and updates on provider information on websites. Works closely with the internal credentialing services for payer credentialing.

Job Responsibilities

Coordinates with over 550 VMG clinicians to update and maintain PECOS and CAQH to ensure accuracy of data to maintain payer credentials and recredentialing for the ability to maintain billing for services rendered to patients. Coordinates and works directly with the clinicians and practice managers for attestation of information in the CAQH system, which is required every 90 days. Maintains all data in the system.

Responsible for maintaining all practice location information for ADA compliance for all payers per their request, as well as the CAQH file.

Responsible to maintain and update the 855B roster of all practices locations for Medicare and Medicaid to obtain payer recredentialing for over 550 clinicians

Manages the Payer Credentialing documents folder to ensure all documents for credentialing are uploaded and maintained. Works with practice manager and/or provider to facilitate the gathering of documents for timely processing into the CAQH system.

Coordinates all quarterly payers audits to ensure accurate roster information is maintained in the payer directories, via spreadsheets and faxed information received. VMG’s contact for payer’s phone calls, emails and faxed requests (demographic calls, ADA forms, demographic information faxes from the payers.

Works with all VMG clinicians to set up PECOS and CAQH accounts as well as establish clinician NPI’s.

Participates frequently in all project related function in department and assists other team members as required.

Required Experience:

2-3 years progressively responsible experience in payer credentialing, and/or physician billing experience

Demonstrates accurate knowledge of payer credentialing guidelines

Experience in utilizing CAQH, NPI and PECOS websites.

Excellent communication (verbal, written) and organizational skills.

Able to work independently.

Attention to detail and accuracy is vital

Ability to work under pressure for a demanding clientele (physicians).

Excellent customer service skills.

Flexibility in order to assist or cover for other team members as required.

Required Education:

High School graduate.

Associates Degree preferred

Training / Certification / Licensures:

National Committee of Quality Assurance Certification (NCQA) preferred.