Credentialing and Coding Coordinator

GENERAL SUMMARY/ OVERVIEW STATEMENT:

The position will work under the direction of the Director of Compliance. Manages the insurance credentialing process at NEW Health and assists with insurance coding and billing issues.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Manage, coordinate, and track all aspects of the process necessary to initially credential and re-credential provider staff with the required government and commercial payers not handled by Mass. General Physicians Organization (MGPO), working closely with the provider staff, the department’s chief/administrative staff, the finance department, and other necessary contacts.
• Maintain a spreadsheet with the status of each credentialing / licensing candidate.
• Independently work with staff to obtain completed paperwork, follow-up on missing or outdated information or any other items requiring further explanation.
• Assist and educate staff on insurance billing protocols, billing/carrier payment and rejection patterns and processes, risk adjustment coding and opportunities for increased reimbursement
• Works with patients to resolve billing problems that Customer Service areas were not able to resolve and require additional follow up for resolution.
• Provides excellent customer service to both internal and external customers.
• Contributes to the teamwork within and between departments.
• Participates in project work and other duties as assigned.
• Attends local and regional billing and coding meetings and disseminates new/evidence-based coding opportunities to the appropriate departments
• In coordination with the finance department, audit billing patterns and make recommendations to optimize practices. Follow up on billing issues with department managers for guidance and resolution
• Keep up-to-date information on documentation requirements for various billable clinical services and educate staff in order to minimize payor retractions

QUALIFICATIONS:

• High school diploma required.
• Bachelor’s degree or 2-4 years related experience preferred.
• Prior credentialing and/or insurance billing experience strongly preferred.
• Knowledge of Joint Commission and NCQA credentialing standards preferred.

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:

• Microsoft Word/Outlook/Excel/Internet/Intranet/Web Competent
• Strong interpersonal, communication and organizational skills
• Strong verbal and written communication skills.
• Ability to handle sensitive and confidential matters discreetly to ensure confidentiality guidelines are maintained.
• Ability to navigate collaborations with individuals at all levels
• Excellent attention to detail.
• Ability to be pro-active, make appropriate decisions and work independently with minimal supervision.

Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged.