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About the Role
The Contract & Credentialing Coordinator is responsible for all aspects of the credentialing, re-credentialing, and privileging processes for practitioners at the Seneca Nation Health System (SNHS). This role ensures providers meet qualification standards and maintains up-to-date files on certifications and contracts.
Responsibilities
- Coordinates timely credentialing, re-credentialing, and privileging of practitioners following NCQA standards.
- Performs Primary Source Verifications of practitioner information in compliance with NCQA and CMS standards.
- Enters, maintains, and updates practitioner information in electronic credentialing software.
- Monitors practitioners due for re-credentialing and ensures timely completion.
- Completes and maintains current and accurate data for all employee and consultant practitioners.
- Contacts appropriate agencies for verification of information including NPDB, NYS Office of the Professions, DEA, etc.
- Prepares and communicates correspondence to practitioners regarding application and re-credentialing review outcomes.
- Maintains knowledge of accrediting bodies' requirements and recommends best practices.
- Maintains copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents.
- Tracks expiration dates of state licenses, DEA certificates, malpractice coverage, and contracts.
- Provides credentialing and privileging verifications.
- Reviews disciplinary action reports and escalates concerns to the Chief Medical Officer.
- Keeps track of annually required provider CEU's.
- Maintains health system practitioners contract files, schedule, and notifies HR of rate increases.
- Maintains a schedule of consultant hours and payments.
- Upholds and promotes the mission statement and values of the Seneca Nation Health System.
- Provides team collaboration through a trauma-informed lens.
- Maintains a detailed log of practitioner administrative times for Medicare and Medical cost reports.
- Maintains confidentiality of all practitioner information.
- Attends all mandatory staff meetings, trainings, and in-services.
- Follows 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
- Professional demeanor
- Independent work
- Team collaboration
- Priority management
- Medical credentialing
- Privileging procedures
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
- Monday - Friday (No weekends and no holidays)
- Health, dental, and vision full coverage for individual - Family option available
- Short term/long term disability options
- Vacation (annual) + PTO (accrued weekly)
- 16 paid holidays in the calendar year
- 401K - 5% matching
- Parental, medical, education, bereavement leaves
About the Company
- The Seneca Nation Health System (SNHS) is dedicated to providing patient care.