Credentialing Coordinator Please see Special Instructions for more details. * Please ensure your full range of knowledge, skills, abilities, experience and education are listed on your application. Do not write 'see resume' on your application when completing the job duties section.* If you answer the questions at the end of the application, please ensure your application reflects the knowledge, skills, abilities and experiences to support your answers (see job duties section of previous employment).* Failure to answer the questions at the end of the application will not preclude your application from being considered but may result in your application not receiving full consideration of your knowledge, skills, and abilities. Position Details

Position Information

Job Title Credentialing Coordinator Position Number 951111 Vacancy Open to All Candidates Time-Limited No Department Homepage http://www.ecu.edu/ecuphysicians/ Advertising Department CLINICAL FINANCIAL SERVICES Division Administration & Finance Classification Title 10301 University Program Speci Competency Level 2 - Journey Working Title Credentialing Coordinator Number of Vacancies 1 Full Time Equivalent (FTE) 1.0 Full Time or Part Time Full Time Recruitment Range $31,888 - $64,115 Anticipated Hiring Range $46,000 - $50,000 Salary Grade Equivalency GN10 Work Schedule M-F Work Hours 8-5pm Position Location (City) Greenville Job Category Staff - Professional Organizational Unit Overview

Clinical Finance and Business Support Services/Group Practice Administration is responsible for the clinical and administrative oversight of the group practice for ECU Physicians. The practice is comprised of approximately 360 faculty physicians, 52 contracted providers and employs a diverse clinical support staff of more than 1,200 individuals, of which approximately 350 employees are working within revenue cycle operations The practice provide approximately 550,000 outpatient, 155,000 emergency room and 126,000 inpatient services annually to nearly 160,000 patients. Clinical Finance and Business Support Services reports to the ECU Physicians (ECUP) Executive Director and ECUP Chief Financial Officer to support key fiscal and operational components of the clinical practice and revenue cycle operations. These include direct management responsibility for staffing and operations in the centralized functions of the Central Billing Office (CBO) and oversight for decentralized activities. Centralized functions include: Payor Contracting and Evaluation, Regulatory Compliance and Credentialing; Computer System and Procedure Training; Insurance and Patient Billing, Follow-up and Collections; Cash Management of Professional Fee Revenue; Business Intelligence Services such a Reporting and Analytics; Coordinated Patient Access Support; and Contact Center Decentralized functions include: Registration, Referral Management, Pre-Service Financial Preparation; Service Identification and Reconciliation; Coding and Charge Entry; and Project Management and Process Improvement.

Job Duties

Tracks the date of provider applications that are submitted until the provider’s credentials are approved.
Confirms that the correct versions of credentialing applications are being used to avoid delays in finalizing the credentialing process. Coordinates communications with department administrators to confirm provider service locations, etc., which is necessary to properly establish the provider in EPIC for billing purposes.
Educates newly credentialed providers on third party payer credentialing and re-credentialing documentation and requirements. Handles all Medicare initial enrollment, re-enrollment, and revalidation activities
Handles all Medicaid Initial enrollment, re-enrollment, and revalidation activities
Medicaid NC Tracks monthly license updates
Medicaid NC Tracks monitoring of Provider Messaging Inbox
Participates in Medicaid onsite screenings. Creates credentialed provider templates that are forwarded to the managed care companies to add our providers in their system as well as creating other provider credentialing reports upon request. Coordinates credentialing activities with McKesson (McKesson is the billing entity used by the Department of Pathology). Monitors third party payors online provider directory to ensure that our providers are loaded correctly and can be viewed by the general public. Monitors, tracks, and reconciles Pro-card statement of charges. These are charges related to the Medicaid Enrollment fee.
Initiates direct communications with providers and clinical staff to explain the credentialing process.
Serves in a liaison capacity between outside agencies and ECUP’s provider(s) on all matters relevant to participation in MCO’s, Medicare, Medicaid, and Tricare.
Maintains, monitors, and updates credentialing databases (Shared Drive and Cactus)
Creates and distributes a Monthly Physician Count Report to administration.
Review monthly disciplinary action reports issued by state licensure bodies, Office of Inspector General, and Medicare and Medicaid Sanctions reports. Creates a Monthly Sanction Report.
Quarterly Reports to all Third Party Payors
Quarterly Provider Roster to Insurance Companies and Internal Departments
Audits: Facilitates the process of scheduling multiple third party payer credentialing audits (BCBS, Tricare, Cigna, Aetna/Coventry, Medcost, CBHA, & ECBH). Serves as a liaison between the MCO and CVO. Gathers information needed from in house, the CVO, and forwards to the plan.
Audits: Facilitate Internal Self Audit
Monitors credentialed provider types to identify providers that are eligible to be reimbursed by our contracted third party payors.
Maintains provider and clinic demographic information.
Responsible for understanding accreditation agency credentialing guidelines (e.g., NCQA, TJC, and URAC). Responsible for understanding healthcare provider license accrediting body guidelines (e.g., NC Medical Board and
U.S. DEA as well as the NC Dept. of Insurance.)
The Credentialing Specialist is directly involved in the orientation of new departmental personnel and faculty regarding the requirements for participation and coverage of services in each of the various MCP’s, Medicare, Medicaid, Champus and BCBS costwise.
The Credentialing Specialist serves in a liaison capacity between outside agencies and the School’s provider(s) on all matters relevant to participation in MCP’s, Medicare, Medicaid, Champus, BCBS. For example, if the Personal Care Plan (PCP) requires additional information from each School of Medicine provider regarding board certification and practice history. The Coordinator would coordinate the gathering of this information from the faculty for submission to PCP.
Systems & Claims

Participates in the development of managed care policies and procedures as they relate to provider participation in the various plans. The Provider Relations Coordinator must be familiar with the criteria for provider participation and coverage of services by each of the various health plans with which the school contracts. Many of the rules for participation and coverage by Medicare, Medicaid, and Campus are mandated by federal law. These laws and associated paperwork are complicated, voluminous, and can result in significant financial penalties and sanctions if not completely adhered to. The coordinator relies upon government publications such as Federal Register, bulletins, and newsletters to stay abreast of these regulations and assure timely completion of necessary paperwork and practice compliance. An example includes enrollment and coverage of non-physician practitioners. The criteria vary by type of practitioner (i.e. nurse practitioner, physician extender, clinical social worker, etc.) and coverage of practitioners’ services is governed by the Health Care Financing Administration (HFCA). HFCA sets forth a set of rules and regulations which are usually more restrictive that State licensing and certification requirements. For enrollment and billing purposes, HCFA regulations must be adhered to.
Each Managed Care Plan also differs in participation requirement at the School, Clinic, and individual provider level. The Provider Relations Coordinator must be familiar with the details of each MCP contract.
Support is provided and oversight for projects that are assigned to other staff or students (i.e., Scanning of Credentialing Files into X-tender or enrollment applications). Has a complete understanding of the Credentialing Coordinator role and steps in to handle issues when the Credentialing Coordinator is not available.
The Provider Relations Coordinator is directly involved in the orientation of new departmental personnel and faculty regarding the requirements for participation and coverage of services in each of the various MCO’s, Medicare, Medicaid, and Tricare cost wise.
Various projects that arise related to provider credentialing and enrollment. This can be due to changes with a MCO or government plan and an action plan that is needed.

CLINICAL SUPPORT POSITION – NOT SUBJECT TO STATE HUMAN RESOURCES ACT.

The ECU Brody School of Medicine is affiliated with Vidant Medical Center. Vidant Medical Center is the flagship hospital for Vidant Health and serves as the teaching hospital for the Brody School of Medicine at East Carolina University.

Minimum Education/Experience

Bachelor’s degree and one year of experience related to the area of assignment; or equivalent combination of training and experience. All degrees must be received from appropriately accredited institutions.

License or Certification required by statute or regulation

None

Preferred Experience, Skills, Training/Education License or Certification required by the Department

None

Special Instructions to Applicant

• Please ensure your full range of knowledge, skills, abilities, experience and education are listed on your application. Do not write ‘see resume’ on your application when completing the job duties section.
• If you answer the questions at the end of the application, please ensure your application reflects the knowledge, skills, abilities and experiences to support your answers (see job duties section of previous employment).
• Failure to answer the questions at the end of the application will not preclude your application from being considered but may result in your application not receiving full consideration of your knowledge, skills, and abilities.

Job Open Date 04/15/2019 Job Close Date - Positions will be posted until 11:59 p.m. EST on this date; If no closing date is indicated, the position will be posted until filled and may close at any time after the recruitment has been completed. 04/25/2019 Open Until Filled No Quick Link for Direct Access to Posting http://ecu.peopleadmin.com/postings/27810 Alternate option

If no applicants apply who meet the required competency level and training & experience requirements, then management may consider other applicants. Salary would be determined based on competencies, equity, budget, and market considerations.

AA/EOE

East Carolina University is an equal opportunity and affirmative action employer and seeks to create an environment that fosters the recruitment and retention of a more diverse student body, faculty, staff and administration. We encourage qualified applicants from women, minorities, veterans, individuals with a disability, and historically underrepresented groups. All qualified applicants will receive consideration for employment without regard to their race/ethnicity, color, genetic information, national origin, religion, sex, sexual orientation, gender identity, age, disability, political affiliation, or veteran status.

Individuals requesting accommodation under the Americans with Disabilities Act Amendments Act (ADAAA) should contact the Department for Disability Support Services at (252) 737-1016 (Voice/TTY).

Eligibility for Employment

Final candidates are subject to criminal & sex offender background checks. Some vacancies also require credit or motor vehicle checks. ECU participates in E-Verify. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. If highest degree earned is from an institution outside of the U.S. and its territories, final candidates are required to have their degree validated as equivalent to the degree conferred by a regionally accredited college or university in the U.S.

Office of Human Resources Contact Information

If you experience any problems accessing the system or have questions about the application process, please contact the Office of Human Resources at (252) 328-9847 or toll free at 1-866-489-1740 or send an email to employment@ecu.edu. Our office is available to provide assistance Monday-Friday from 8:00-5:00 EST.

Supplemental Questions

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Documents Needed To Apply Required Documents

Optional Documents

1. Curriculum Vitae/Resume
2. Cover Letter
3. List of References