TriHealth

This position’s primary focus is on the resolution of claim errors, rejections, and denials as it relates to provider enrollment, network participation, address discrepancies, etc. This team member will work closely with Professional Billing, Provider Enrollment, and Information Systems teams. Must be comfortable working independently to research issues and with presenting findings to internal and external teams. Candidate must have excellent organizational, trending, and tracking abilities. Requires demonstrated proficiency in Epic, Microsoft Applications, and the PB Revenue Cycle. Must be willing to learn new systems related to credentialing and provider enrollment. Position is on-site in Norwood, OH with the option to work remotely 1-2 days per week as business needs allow.

Job Overview

The Professional Billing Credentialing Coordinator works under the direct supervision of the Supervisor of Credentialing. Duties and responsibilities include: carrying out all aspects of the provider credentialing process for commercial and government payers; performing data entry of provider information into the credentialing database and the National Provider DataSource (CAQH); obtaining and maintaining all provider recertification and revalidation documents; developing and maintaining good working relationships with payer representatives, physician offices and the Managed Care Contracting Team; provide assistance and back up to other team members as needed; have excellent written and verbal communication skills; have an accuracy and attention to detail; excellent time management skills.

Job Requirements

High School Degree

Credentialing experience with commercial and government payers

2-3 years experience

Job Responsibilities:

Accurately maintains provider data is credentialing database and ensures confidentiality of provider data.

Assist with questions from billing and coding teams with the goal of reducing the number of non-participating provider claim denials.

Assure that all providers are credentialed with all government payers and contracted commercial payers.

Complete revalidations and re-certifications required by government payers and respond to re-credentialing requests from commercial payers in a timely manner.

Demonstrates strong verbal and written communication skills.

Develops and maintains confidential filing systems, copying, misc. clerical support.

Participates as a team member, offering back up and support and willingly takes on new assignments.

Other Job-Related Information

Working Conditions

Climbing - Rarely

Hearing: Conversation - Consistently

Hearing: Other Sounds - Frequently

Kneeling - Occasionally

Lifting 50+ Lbs. - Rarely

Lifting <50 Lbs. - Occasionally

Pulling - Rarely

Pushing - Occasionally

Reaching - Rarely

Sitting - Consistently

Standing - Rarely

Stooping - Occasionally

Talking - Consistently

Use of Hands - Consistently

Color Vision - Occasionally

Visual Acuity: Far - Frequently

Visual Acuity: Near - Consistently

Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS…

• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas

Excel: ALWAYS…

• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service

Respect: ALWAYS…

• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone’s opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS…

• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS…

• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community
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• 4600 Wesley Ave, NORWOOD, OH, 45212, US
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