Sobre este puesto de Duals Credentialing Coordinator I en Mass General Brigham
Mass General Brigham · Presencial · Somerville-MA
Site: Mass General Brigham Health Plan Holding Company, Inc.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
The Credentialing Coordinator I is responsible for the processing, reviewing, and maintaining provider and facility credentialing and re-credentialing files within department turnaround and quality standards. He/she is responsible for working with the management team to monitor compliance of current workflows, assisting with defining revised workflows, and for distributing the day's assignments in the absence of the manager.
Essential Functions:
• Enters and updates provider and facility data in credentialing database, PEP, and QNXT while still adhering to input standards, including for the OneCare and SCO lines of business.
• Works with External Credentialing Verificaiton Organization (CVO) on processing Credentialing Information and Reporting, as well as Delegate Credentialing information.
• Maintains required ongoing monitoring and sanctions reporting.
• Coordinates the processing of initial and re-credentialing applications within the established turnaround times while ensuring that Mass General Brigham Health Plan meets all State and NCQA requirements through the HCAS (HealthCare Administrative Solution) streamlined credentialing process.
• Conducts verification of credentialing elements completed by CVO (ie. license, DEA, board certification, and NPDB) through the use of system resources, and documents the status in the credentialing database and PEP.
• Performs review and analysis of provider and facility credentialing and re-credentialing applications to determine completeness. This would also include notifying providers when their applications are incomplete or missing information.
• Provide representation, assistance, and guidance on the credentialing process during committee meetings.
• Meets or exceeds all department quality standards for all initial and re-credentialing files.
• In the absence of the manager, interacts and responds to inquiries from teammates with specific questions.
• Hold self and others accountable to meet commitments.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.Remote399 Revolution Drive40RegularDay (United States of America)8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
The Credentialing Coordinator I is responsible for the processing, reviewing, and maintaining provider and facility credentialing and re-credentialing files within department turnaround and quality standards. He/she is responsible for working with the management team to monitor compliance of current workflows, assisting with defining revised workflows, and for distributing the day's assignments in the absence of the manager.
Essential Functions:
• Enters and updates provider and facility data in credentialing database, PEP, and QNXT while still adhering to input standards, including for the OneCare and SCO lines of business.
• Works with External Credentialing Verificaiton Organization (CVO) on processing Credentialing Information and Reporting, as well as Delegate Credentialing information.
• Maintains required ongoing monitoring and sanctions reporting.
• Coordinates the processing of initial and re-credentialing applications within the established turnaround times while ensuring that Mass General Brigham Health Plan meets all State and NCQA requirements through the HCAS (HealthCare Administrative Solution) streamlined credentialing process.
• Conducts verification of credentialing elements completed by CVO (ie. license, DEA, board certification, and NPDB) through the use of system resources, and documents the status in the credentialing database and PEP.
• Performs review and analysis of provider and facility credentialing and re-credentialing applications to determine completeness. This would also include notifying providers when their applications are incomplete or missing information.
• Provide representation, assistance, and guidance on the credentialing process during committee meetings.
• Meets or exceeds all department quality standards for all initial and re-credentialing files.
• In the absence of the manager, interacts and responds to inquiries from teammates with specific questions.
• Hold self and others accountable to meet commitments.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
Qualifications
Education
- Associate's Degree preferred
Experience
- At least 1-2 years of experience in Clinical/Medical Office/Healthcare required
- Experience with audits, credentialing, or reading credentialing files highly preferred
- At least 2-3 years of previous credentialing experience, with at least 1 year in a health insurance environment, highly preferred
- Experience with OneCare and/or SCO highly preferred
Knowledge, Skills, and Abilities
- Knowledge of medical provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
- Competence in Microsoft Office including Outlook, Excel, and Word.
- Ability to use independent judgment and to manage and impart confidential information.
- Skill in establishing priorities with independent coordination of day-to-day aspects.
- Ability to communicate effectively both orally and in writing.
- Information research skills.
- Ability to handle multiple tasks.
Additional Job Details (if applicable)
Working Conditions
This is a remote role that can be done from most US states
This is a full-time Eastern Standard schedule (e.g. 8-4:30 pm or 8:30-5:00 pm ET)
Remote workdays require a stable, secure, quiet, and compliant workspace
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Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$17.71 - $25.28/Hourly
Grade
2
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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