Provider Enrollment & Credentialing Representative at Beacon Health Systems in Granger, Indiana

Job Description:

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  JOB SUMMARY
  
  • Reports to the Manager, Provider Enrollment & Credentialing. Responsible for the timely completion of initial and re-credentialing for Beacon Health System, which includes Beacon Medical Group (BMG) physicians and employed allied health providers, as well as physicians and allied health providers for Memorial Hospital of South Bend, Elkhart General Hospital, Beacon Health Ventures, Beacon Health LLC, and all Community Health Alliance (CHA), and Credentialing Verification Organization (CVO Alliance) contracted providers. Coordinates efforts with physicians and providers, credentialing agencies, regulatory agencies, payors, office managers and contracted providers to complete the credentialing process in accordance with the National Committee on Quality Assurance (NCQA) standards and departmental policies and procedures. Develops systems to review applications for provider and facility credentialing.
    
    
  
  


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  MISSION, VALUES and SERVICE GOALS
  
  
  
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    MISSION: We deliver outstanding care, inspire health, and connect with heart.
    
    
  
  
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    VALUES: Trust. Respect. Integrity. Compassion.
    
    
  
  
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    SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.
    
    
  
  
  
  


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  JOB SPECIFICATIONS
  
  
  
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    Education and Experience
    
    • The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent); an Associate's Degree in Business, Health Administration or a related field is preferred. Three years of related credentialing experience and/or experience in the healthcare or health insurance industry is desired.
      
      
    
    
  
  
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    Knowledge & Skills
    
    
    
    • Requires a working knowledge of federal, state and local laws and NCQA standards applicable to assigned areas of responsibility.
      
      
    
    
    • Demonstrates the analytical, problem-solving and organization skills necessary to develop and implement methods and procedures for improving and facilitating the credentialing processes.
      
      
    
    
    • Requires solid office skills (including the ability to take minutes at meetings) and the ability to operate standard office equipment. Also requires basic math skills.
      
      
    
    
    • Demonstrates proficient computer skills (data entry, word processing and spreadsheets). A basic understanding of database applications is desired.
      
      
    
    
    • Demonstrates excellent communication skills (both verbal and written).
      
      
    
    
    • Requires the interpersonal skills necessary to interact effectively with a wide variety of internal and external contacts. Also requires the ability to develop and maintain effective working relationships.
      
      
    
    
    
    
  
  
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    Working Conditions
    
    
    
    • Works in an office environment.
      
      
    
    
    • Requires the ability to work flexible hours, which may vary according to the department's needs.
      
      
    
    
    
    
  
  
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    Physical Demands
    
    • Requires the physical ability and stamina to perform the essential functions of the position.