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About the Role
The Contract & Credentialing Coordinator is responsible for managing the credentialing, re-credentialing, and privileging processes for practitioners at the Seneca Nation Health System (SNHS). This role ensures providers meet qualification standards, maintains up-to-date files, and manages practitioner contracts and certifications.
Responsibilities
- Coordinate timely credentialing, re-credentialing, and privileging for Physicians, Dentists, Licensed Independent Practitioners, and Advanced Practice Professionals according to NCQA standards.
- Perform Primary Source Verifications of practitioner information in compliance with NCQA and CMS standards.
- Enter, maintain, and update practitioner information in electronic credentialing software accurately and timely.
- Maintain current knowledge of Medical Staff Bylaws, Rules & Regulations, and Credentialing policies.
- Monitor practitioners due for re-credentialing and ensure timely completion.
- Complete and maintain current and accurate data for all employee and consultant practitioners.
- Contact hospitals and agencies for verification of information including NPDB, NYS Office of the Professions, NYS Dept. of Health Office of Professional Medical Conduct, DEA, licensure, professional education, board certification, residency/fellowship training, and peer recommendations.
- Prepare and communicate correspondence to practitioners regarding application and re-credentialing review outcomes.
- Maintain knowledge of accrediting bodies' requirements and recommend best practices.
- Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all practitioners.
- Track expiration dates of all state licenses, DEA certificates, malpractice coverage, and contracts.
- Provide credentialing and privileging verifications.
- Perform timely reviews of disciplinary action reports from State licensure bodies, Medicaid, and other agencies, escalating issues to the Chief Medical Officer.
- Keep track of annually required provider CEU's, including allowance and usage.
- Maintain health system practitioners' contract files and schedules, notifying HR of rate increases.
- Maintain a schedule of consultant hours and payments.
- Uphold and promote the value and integrity of the Seneca Nation Health System’s mission statement.
- Promote SNHS in a positive manner.
- Provide team collaboration through a trauma-informed lens, incorporating principles of safety, trustworthiness, transparency, collaboration, empowerment, and respect for diversity.
- Maintain a detailed log of practitioner administrative times for annual Medicare and Medical cost reports.
- Maintain confidentiality of all practitioner information.
- Attend all mandatory staff meetings, trainings, and in-services.
- Follow all department, SNHS, and Seneca Nation policies.
Requirements
- Experience with data entry.
- Working knowledge of Windows, Microsoft Word, Excel, and Outlook.
- Ability to work independently and as an effective team member.
- Ability to manage competing priorities.
- Knowledge of medical credentialing and privileging procedures and standards.
Skills
- Data entry
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Verbal communication
- Written communication
- Medical credentialing
- Privileging procedures
- Contract management
Location
- Seneca Nation Health System
Work Type
- Full-time
- Monday - Friday
Experience Level
- Minimum of 2 years of credentialing experience with hospital medical staff or equivalent preferred.
- Associate’s degree with a minimum of three years’ office experience in a healthcare setting.
Education Level
- Associate’s degree
- NAMSS Certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) preferred, or equivalent with intent to pursue NAMSS or CPMSM within first year of accepting position.
Benefits
- Health, dental, and vision full coverage for individual
- Family health coverage option available
- Short term/long term disability options
- Annual vacation
- Weekly accrued PTO
- 16 paid holidays
- 401K with 5% matching
- Parental leave
- Medical leave
- Education leave
- Bereavement leave
About the Company
- The Seneca Nation Health System (SNHS) is dedicated to providing patient care.