Position Goal

Serve as a key member of the Credentialing Team, which includes both privileging and payor enrollment, by maintaining up-to-date knowledge of external partners policies and procedures to facilitate efficient and effective Credentialing processes for Hughston and its affiliated providers.  Collaborate with internal stakeholders to ensure effective communication.

Position Responsibilities:

Assist the System Director of Credentialing in overseeing the credentialing process for the organization and all healthcare providers; to include JHMH, HSC and Valdosta Surgery Center. Oversee the maintenance of industry standards and regulations. Maintain best practices for payer enrollment and ensure communication of changes to relevant stakeholders. Assist in the development of credentialing policies and procedures. Provide day-to-day guidance to Credentialing Teams: Payor Enrollment and Privileging. Review and maintain payor provider directories. Collaborate with the Billing Department to ensure successful reimbursement of claims submitted to payors related to enrollment activities. Collaborate with sister departments (Revenue Integrity and Managed Care) to facilitate efficient credentialing process. Ensure accurate and up-to date provider data is maintained in digital platforms (i.e. Athena/Verity) Establish and maintain strong relationships with external stakeholders to facilitate smooth communication and problem resolution. Provide support and education to the Credentialing Teams regarding processes and requirements. Provide ongoing assessment to ensure compliance with The Joint Commission, Medicare COP and AAAHC standards. Conduct regular audits to ensure ongoing compliance with credentialing standards and accurate enrollments. Facilitate processes to allow for increased efficiency of the payor enrollment process. Ensure maintenance of all CAQH/PECOS/NPPES profiles for all providers. Complete and coordinate paperwork for ERA, EDI, EFT, and other electronic channels between the organization and payers in the electronic billing system, and with enrollment services. Ensure all credentialing processes are completed timely to prevent any lapse in enrollment or appointment. Monitor for trends in enrollment process completion to establish timely resolution and eliminate delays. Manages credentialing department staff.  Provides direction necessary feedback, job performance reviews and approves and monitors time.

Maintain confidentiality of provider information.

Experience:

Required:

Three years of credentialing and/or payor enrollment experience in a healthcare setting 1 year management experience

Education:

Required:

Associate degree or higher in related field

Preferred:

Provider Enrollment Specialist Certification (PESC).

Special Qualifications:

Required:

Strong knowledge of credentialing standards, regulations, and processes Ability to work independently with minimal supervision. Requires skill in computer systems and applications. Must have outstanding organizational Must have outstanding communication skills (oral/written). Must be able to prioritize work to meet deadlines despite frequent interruptions. Exceptional attention to detail and high level of accuracy. Ability to work in a team environment. Must be able to prioritize tasks and use good professional judgment in assigned dutie Must have a valid driver’s license and a satisfactory Motor Vehicle Record (MVR)

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.