Primary Source Verification Coordinator, Central Verification Office, Full-Time (Hybrid)
Category: Administrative/General Support
Facility: Luminis Anne Arundel Medical Center
Location: Annapolis, MD
Posted Date: July 14, 2022
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The Primary Source Verification Coordinator is responsible for initiating sending out online Applications, reviewing and processing credentialing applications for Initial and Reappointment. There are Credentialers supporting documentation for the purpose of enrolling individual physicians and physician groups with payers. This individual must maintain accurate records for each provider at all times within the Credentialing Program. This individual is an essential part of the new provider initial credentialing process as well as existing provider Reappointment process.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Maintains integrity of Credentialing database, by entering new providers and updating provider and practice information on an as needed basis. Completes Initial and Reappointment timely manner and turned overed to the Medical Staff Office for Privileging Process. Maintains integrity of provider online files, prescribed formats.
- PE Coordinators prepare the CAQH application for newly affiliated and existing healthcare providers Maintains credentialing online databases and ensures up-to-date tracking of file process.
- Display in-depth knowledge of and execute all CVO Guidelines and standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership.
- Plan Enrollment Credentialers will have In-depth working knowledge of the various payer applications associated and the workflow process.
- Ensure all workflow items are completed within the set turn-around-time, meeting quality expectations.
- Takes an active role in improvement process, anticipates problems, makes suggestions and works with the Data Analyst to resolves minor system obstacles.
- Interact professionally with providers and staff representatives to obtain information on any necessary documentation required for processing.
- PE Coordinators and Expirables Coordinator generates letters to practice leadership in advance of documents' expiration dates to request electronic copies of current documents. (E.g. license, CDS, DEA, malpractice insurance certificates)
- Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.
- Ability to work within a deadline-intense environment.
- Educational/Experience Requirements:
- 3 years of experience in a centralized credentialing office or medical staff credentialing and direct provider enrollment experience, such as credentialing or file maintenance, preferred with experience in Word and Excel
- Knowledge of health plan and governmental payer credentialing, enrollment and requirements acquired through completion of a CPCS certification course, or sufficient job-related experience with intent to pursue certification.
- Knowledge of Microsoft Word and other PC applications including preferred experience in a medical staff electronic database system
- Knowledge of PECOS and State Medicaid Enrollment applications
- Knowledge of standards interpretation as related to NCQA
RequiredLicense/Certifications: Certified Professional Credentialing Specialist (CPCS) Preferred
Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands –
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.
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Important Information about CPR (BLS) requirements for Luminis Health. (Note: this downloads a word document)