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Aurora Health Care · 8 hours ago

MC Credentialing Coord

Allenton, WI

Full-time

Onsite

Mid Level

$23/hr - $35/hr

4+ years exp

Aurora Health Care is seeking a Managed Care Enrollment Coordinator to facilitate the enrollment of providers within Advocate Aurora Medical Group. The role involves managing the credentialing process, maintaining communication with various departments, and ensuring compliance with deadlines and policies.

Health Care

Responsibilities

Manages enrollment of all employed and contracted AAMG providers by applying subject matter expertise skills based on specific hiring/contractual arrangements to decide appropriate credentialing variables, demographics and service line

Participate and/or request meetings with key contacts in AAMG to sort out appropriate credentialing route and enrollment processing of providers hired/contracted under a unique arrangement/contract

Collaborating with multiple departments/areas to streamline the above processes

Adheres to deadlines and scheduled managed care credentialing committees by tracking files through all stages

Day-to-day responsibility for maintaining proactive communication with internal and external individuals regarding credentialing, enrollment and government payor activation processes

Oversee receipt/review and processing of all practitioner demographic/specialty/other changes and resignation requests to be delivered to APP Network Management team for processing and distribution to commercial payers

Communicate regularly via phone, fax, or written correspondence with Credentials Verification Office, Hospital medical staff offices, contract entities, physicians and group practice offices

Provide direct support to Managed Care Credentialing coordinators in the processing of verifications and database maintenance of credentialing elements for new applicants and reapplicants

Also in tracking timely submission of recredentialing applications from AAMG

Data entry and record keeping of ancillary practitioners employed by AAMG

Track expirables of licensure, insurance and board certification for all AAMG practitioners credentialed members of APP

Respond to internal/external questions and resolutions of problems relative to delayed, incomplete or problematic matters, specific to credentialing and provider enrollment according to established policies/procedures

Represent team in medical group AAMG Acquisitions team, AAH Payer Activation, Advocate Intensivists and Office of APC weekly meetings

Qualification

Credentialing softwareDatabase managementRegulatory agenciesMicrosoft OfficeManage prioritiesCommunication skillsOrganizational skillsProblem solving skills

Required

High School Graduate

Four (4) years' experience in administrative support position including database management

Excellent communication, organizational and problem solving skills

Advanced Proficiency in the use of Microsoft Office (Excel, Access, PowerPoint and Word) and credentialing software

Knowledge of accrediting and regulatory agencies as related to the Medical Staff, including (but not limited to) Joint Commission, DNV, HFAP, CMS, OSHA, NCQA and State and Federal Law and other standards and regulations, and hospital and system-wide policies regarding licensed independent practitioners in the hospital setting required

Must have proven track record of effective interactions with physicians and other health care professionals

Ability to work effectively and independently

Demonstrated ability to effectively manage multiple priorities