• Job Type: Officer of Administration
• Regular/Temporary: Regular
• Hours Per Week: 35
• Standard Work Schedule: M-F, 9AM-5PM
• Building: 400 Kelby street, Fort Lee NJ 07024
• Salary Range: $75,000 - $80,000

Position Summary

The Provider Enrollment Group (PEG) is the central ColumbiaDoctors unit responsible for payer credentialing and enrollment services. The Senior Provider Enrollment & Credentialing Coordinator performs analytical provider enrollment and credentialing functions with payers, vendors, and practices.

Responsibilities

Technical

• Prepares, submits, and tracks payer enrollment and credentialing material submissions. Identifies variances, issues, and delays, addressing them in a timely manner, escalating with internal and external stakeholders and management as needed.
• Performs ongoing outreach and follow-up with providers, payers and vendors, ensuring that contractual obligations in terms of turnaround timeframes, credentialing and loading requirements are met, escalating when deficiencies are identified.
• Audits materials returned by providers, payers, and vendors for accuracy and completeness, addressing variances in a standardized way according to well-defined standard operating procedures.
• Prepares and distributes status updates to stakeholders for accurate and timely updating of internal and external platforms (including but not limited to databases, credentialing grids, dictionaries, portals, and websites).
• Serves as a key contributor to special credentialing, enrollment, and operational projects, including large-scale initiatives and centralization of additional services and functions.
• Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures. Proficient in excel to utilize v-lookup, pivot tables, concatenation, and other reporting tools to validate data from multiple sources.
• Serves as the primary point of contact for providers, payers, and vendors. Leads regular meetings to discuss the status of open items and deliverables, preparing agenda in advance, and following-up with meeting minutes. Escalates to internal and external stakeholders as needed.
• Troubleshoots credentialing associated denials/underpayments, collaborating with stakeholders to complete a comprehensive root-cause analysis, following through to resolution to minimize adverse impact to revenue and patient/provider abrasion.
• Identifies trends impacting multiple providers, payers and/or groups. Prepares and distributes status reports, making recommendations for next steps and escalating to internal and external stakeholders.
• Performs scheduled and ad-hoc audits of payer and vendor data ensuring updates are made in credentialing database and discrepancies are addressed with external parties.
• Administers credentialing processes in accordance with NCQA guidelines, including quality assurance and compliance tasks, delegated credentialing payer audits/reporting, and coordination of Credentialing Committee processes.
• Collaborates on cross-functional projects, delegating tasks as deemed appropriate, asking for guidance when required and provides cross-coverage for a wide range of related responsibilities.
• Establish and maintain positive relationships with payers, providers, practices and administration, providing subject matter expertise and tailoring communications to adapt to each audience.
• Effectively communicates through informal and formal presentations for various audiences to ensure relevant communication are cascaded to the various interest and stakeholder groups as needed.

Strategy

• Works collaboratively with fellow team members to regularly evaluate the
• effectiveness of department Standard Operating Procedures and workflows and identify gaps. Provides feedback and recommendations to supervisor for improvements. Implements approved changes.

People

• Mentors others in individual and team accountability, modeling behavior, and demonstrating best practices/techniques.

Other

• Performs other related duties as assigned within the scope of practice.
• Maintain familiarity and stay current with NCQA requirements and health insurance plan procedures.
• Represents PEG on committees, task forces, and workgroups as assigned.
• Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.

Minimum Qualifications

• Bachelor’s degree or equivalent in education and experience.
• A minimum of 3 years of related experience.
• An equivalent combination of education and experience will be considered.
• Must demonstrate advanced analytical and problem-solving skills with attention to detail and accuracy.
• Advanced time management skills including planning, organization, multi-tasking, and ability to prioritize required.
• Must demonstrate effective communication skills both verbally and written.
• Specialized knowledge of managed care Credentialing/Enrollment.
• Intermediate knowledge of Microsoft Excel (e.g. vlookup, pivot tables, etc.) or similar software is required.
• Must be a motivated individual with a positive and exceptional work ethic.
• Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
• Must successfully complete systems training requirements.

Preferred Qualifications

• NAMSS Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM) preferred.
• Prior experience with IntelliCred, Cactus or similar credentialing systems is preferred.
• Prior experience at an academic medical center or health insurance plan is preferred.

Other Requirements

Core Competencies

Accountability  &  Self-Management

Level 3 - Intermediate

Adaptability to Change

Level 2 - Basic

Communication

Level 2 - Basic

Customer Service-Patient Focus

Level 3 - Intermediate

Emotional Intelligence

Level 2 - Basic

Problem Solving & Decision Making

Level 3 - Intermediate

Productivity & Time  Management

Level 3 - Intermediate

Teamwork  &  Collaboration

Level 2 - Basic

Quality & Compliance Focused

Level 3 - Intermediate

Leadership Competencies

Performance Management

Level 2 - Basic

Equal Opportunity Employer / Disability / Veteran

Columbia University is committed to the hiring of qualified local residents.