At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.

Mission/Core Values:

It is expected that all of the duties and responsibilities of this position will be performed In a manner consistent with Mercy Health's Standards of Behavior (CARE; Compassion: seeks to understand, listen and explain; Advocate: Is the voice for the vulnerable; Respect: demonstrates the highest regard for and welcomes all people; Excellence: commits to the highest standard of quality care, joyful service, and teamwork) and in a manner that reflects the core values of Mercy Health which are: Excellence, Human Dignity, Justice, Compassion, Sacredness of Life and Service. All supervisors and above are expected to model the organizational mission and values through their daily actions, decision making and priority setting. All supervisors and above are expected to develop, implement and monitor short- and long-range plans to meet or surpass standards consistent with the overall strategic plan.

Summary:

Follows established procedures for enrolling providers with managed care plans and maintain the Council of Affordable Quality Health (CAQH) applications. Assures that procedures are followed meticulously while processing each application. Maintains high level of teamwork, customer service and consistency within the Division. Administers the many challenges faced by the medical staff and allied health professionals that result from the enrollment credentialing and recredentialing process.

ESSENTIAL FUNCTIONS

• Compiles, audits and expedites all information in the CAQH database and confidential credential files. Facilitates all of the credentialing functions and application management. Consistently updates credentialing databases and designed spreadsheets with demographic information and constructs various reports.

• Disseminates demographic provider and practice location changes to the Central Credentialing Office for every change and emailing all changes to the managed care plans MHP Management Team, Senior Account Consultants, the Management Team at the Corporate Physician Business Center and Catholic Health Partners. Serves as a role model to set the standards of behavior, professionalism, and outstanding customer services in all relationships with all customers, internal and external.

• Collects provider identification (NPI) login numbers and passwords for all new providers at on-boarding. Revises National Plan & Provider Enumeration System (NPPES) database for new providers. Maintains spreadsheet with appropriate information. Follows up with providers for any needed information

Determines and implements, if needed, a Clinical Laboratory Improvement Amendment (CLIA) and Terminal Distributor of Dangerous Drugs (TDDD) application for provider (s) practice location at time of on-boarding new providers. Spreadsheet maintenance and CUA certificate updates.

Contacts manage care plan representatives weekly for new provider enrollment effective dates. Designs and updates appropriate spreadsheets on a regular basis. Completes the "Enrollment Form" daily and communicates weekly to the appropriate divisional and corporate management teams and Senior Account.

Complies with Federal, State, Center for Medicare & Medicaid Services (CMS), National Committee for Quality

Assurance NCQA and The Joint Commission standards throughout the enrollment and recredentialing process.

Organize confidential provider credential files to only include the CAQH application, appropriate and legible training documents, updated professional expire able documents and copies of all enrollment communications.

MINIMUM EDUCATION

Required Minimum Education:

High School Diploma

Preferred Education:

Associate Degree

Specialty/Major:

Business, healthcare or related field

Combination of post-secondary education and experience will be considered in lieu of degree.

LICENSURE/CERTIFICATIONS (must be non-expired/active unless otherwise stated):

Required: Certified Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) by National Association of Medical Staff Services or pursuing within 4 yrs. of hire date .

Minimum Years and Type of Experience:

3 years of experience in a related position (preferably with medical staff services or payer enrollment). Associates degree may be accepted in lieu of experience.

Other Knowledge, Skills and Abilities Required:

• Knowledge of insurance regulations, adjudication guidelines and policies and the ability to understand Managed Care Payor contracts is required.

• Excellent phone etiquette and strong internal/external customer service skills required.

• Knowledge of relevant State, Federal and regulatory regulations.

• Knowledge of accrediting regulatory standards and Bylaws related to credentialing.

• Knowledge and understanding of hospitals and healthcare trends.

• Computer skills and experience to include database management and word processing.

• Effective oral and written communication skills as well as strong organizational skills.

• Attention-to-detail; ability to monitor and track many data elements and timelines.

Many of our opportunities reward* your hard work with:

Comprehensive, affordable medical, dental and vision plans

Prescription drug coverage

Flexible spending accounts

Life insurance w/AD&D

Employer contributions to retirement savings plan when eligible

Paid time off

Educational Assistance

And much more

*Benefits offerings vary according to employment status

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com