Provider Enrollment Credentialing Coordinator

• Provider Enrollment Credentialing Coordinator, Medical Staff Office, Days, 80 Hrs / 2 wks
• Location: Mercyhealth Trauma Center; Janesville, WI. Hybrid work schedule opportunity avaliable after training period.

Responsible for the coordination of the provider credentialing activities within the Department of Patient Accounts, to include being the organizational resource for government/third party payer credentialing regulations, and in maintaining systems which are consistent with current industry standards. As appropriate, responsible for the application process for provider numbers for Durable Medical Equipment (DME) and for obtaining the appropriate laboratory numbers by physician for Illinois Department of Public Aid. Performs other duties as assigned.

Essential Duties and Responsibilities

• Understands and maintains an in depth knowledge regarding the requirements for credentialing physicians with Wisconsin and Illinois Medicare, Medicaid, Blue Cross and other third payers as necessary.
• Responsible for implementing and obtaining NPI numbers per provider.
• Works closely with the Medical Staff Office, Clinic Directors, Clinic Finance, Information Systems and physician recruiters to obtain necessary information on new physicians to complete the credentialing process, in a timely manner, necessary to get claims paid.
• Understands the idiosyncrasies of the government forms, which forms are used and what information is necessary for credentialing physicians, physical therapists, CRNAs (Nurse Anesthetists), Physician Assistants, and residents.
• Responsible for investigation or follow-up of claims work que.
• Understands facility enrollment as appropriate.
• Utilizes a system, such as CACTUS, to house and maintain all credentialing information, to include, but not be limited to: when applications are submitted, when payer numbers were received, and what numbers have been assigned to each individual, by location and payer. Ensures confidentiality and accuracy of all credentialing information.
• Utilizes the information in Cactus to ensure the re-credentialing process begins prior to any expiration of current statuses/numbers.
• Obtains and maintains information necessary for credentialing Illinois physicians with each Mercy laboratory in Illinois with the Illinois Department of Public Aid. Processes information on a timely basis and monitors expiration dates.
• As appropriate, is knowledgeable and completes forms/documents as necessary for obtaining provider numbers for Durable Medical Equipment (DME) by location. Monitors expiration dates and initiates the re-certification process in a timely manner.
• Responsible for ensuring that all the data maintained in Cactus is current and that all personal information is kept confidential.
• Responsible for communicating payer numbers received to a Patient Accounts Application Analyst to ensure the McKesson Plus system is current with the information necessary for timely billing of claims.
• Provides reports as necessary for the Credentialing Committee, Patient Accounts, clinics, etc.
• Facilitates communication within Mercy Health System on the credentialing process by being an active participant on the Credentialing Committee.
• Develops, maintains, and implements policies and procedures necessary to support the credentialing process.
• Responsible for educating partners in the application of the credentialing policies and procedures

Education and Experience

Associates degree AND 1 year of experience in a healthcare-related environment, preferably in credentialing/provider enrollment;

OR minimum 3 years of experience in a healthcare-related environment required, preferably in credentialing/enrollment.

Certification and Licensure

Associate's degree and 1 year of healthcare credentialing/enrollment experience preferred (healthcare facility, managed care setting, CVO, medical staff office, or enrollment), or a minimum of 5 years of experience in credentialing (preferred), or a minimum of 5 years of experience in a healthcare business support area required.
Three years' experience working with Wisconsin and Illinois Medicare and Medicaid credentialing regulations, plus managed care payers preferred.

Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to:

* Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.

* Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.

* Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.

* Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.

* Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.

* Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.