Job Description

SENIOR CREDENTIALING AND MANAGED CARE COORDINATOR

Sagis Diagnostics is an entirely physician-led pathology group backed by a CLIA and CAP-accredited histology laboratory. With board-certified and subspecialty-trained pathologists always within reach, we deliver the highest quality services to physicians, physician groups, ambulatory surgery centers, and hospitals.

Our commitment to quality and excellence is built upon our expertise and the utilization of the latest diagnostic tools. Providing accurate, prompt, and clear diagnoses in a personal and customizable manner, we prioritize our referring physicians’ needs. As a patient-centric facility, we strive to deliver the best medical care possible.

SENIOR CREDENTIALING AND MANAGED CARE COORDINATOR

Position Summary :

This role works as part of a team that is responsible for all of the administrative components of the physician credentialing process for hospitals, surgery centers, Medicare, Medicaid, and managed care and commercial insurance companies. In addition, this role will be responsible for building relationships with key contacts at managed care companies. Duties will include negotiating new contractual arrangements, assessment of contract rates and terms, problem solving, and acting as a liaison between third party payors and the physician group. The position supports internal and external tracking of credentialing for all the physicians, reporting, and maintaining continuity/accuracy of data and reconciliation updates.

Responsibilities:

• Maintains third party payor contracts and provider enrollment including Medicare and Medicaid and keeps files up to date on a daily basis.
• Coordinates negotiation and implementation of commercial contracts and payors.
• Monitors and communicates changes in payment schedules, reimbursements and expiration dates of third-payor contracts to senior management of the company.
• Recommends new strategic managed care opportunities to the physician group.
• Completes applications for payor contracts and analyzes contract offers from payors to ensure offerings are competitive within the market.
• Assists Credentialing and CME Coordinator with licensing applications to medical boards in order to obtain state medical licenses for both existing and new providers.
• Assists with preparation of initial and reappointment applications to establish and maintain active hospital medical staff privileges for physicians.
• Assists with maintenance of tracking programs to identify needed CME for physicians based on state licensing requirements.
• Maintains managed care database, directories, etc.
• Performs other job-related duties as assigned

Knowledge and Skills:

• Bachelor’s degree preferred
• 5-7 years of working with Managed Care/Third Party Payors and medical credentialing experience required
• Proficient in Microsoft applications
• Highly attentive to details
• Excellent organization skills required
• Excellent written and verbal communication

Supervisory Responsibility:

• This position has no supervisory responsibilities

Work Environment:

• While performing the duties of this job, the employee regularly works in an office setting

Physical Demands:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job
• While performing the duties of this job, the employee is regularly required to type, file, sit for extended periods of time and lift office supplies up to 20 pounds. The employee is frequently required to stand, talk and hear.

Job Tags

Similar Jobs