Navigant Consulting Inc Credentialing Coordinator - Navigant BPM - Mitchell, SD in Mitchell, South Dakota

Navigant Consulting, Inc. (NYSE: NCI) is a specialized, global professional services firm that helps clients take control of their future. Navigant’s professionals apply deep industry knowledge, substantive technical expertise, and an enterprising approach to help clients build, manage and/or protect their business interests. With a focus on markets and clients facing transformational change and significant regulatory or legal pressures, the Firm primarily serves clients in the healthcare, energy and financial services industries. Across a range of advisory, consulting, outsourcing, and technology/analytics services, Navigant’s practitioners bring sharp insight that pinpoints opportunities and delivers powerful results. More information about Navigant can be found at navigant.com.

Navigant Cymetrix unites the strengths of four category-leading companies to address the complexities of today’s healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.

Under general supervision, the credentialing coordinator obtains provider information for all new providers. Provides new and updated billing information to appropriate carriers to obtain and maintain provider numbers. Maintain complete, current, and accurate database and scanned image file on each medical provider. Review all carrier and other agency directories to ensure all physicians are listed appropriately. Coordinate credentialing process with other offices.

Essential Job Functions

Must be self-directed / self-motivated; must have good communication and interpersonal skills. Must be able to: (1) perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure; (2) accept responsibility for the direction, control and planning of an one’s own work; (3) work independently; (4) recognize the rights and responsibilities of patient confidentiality; (5) relate to others in a manner which creates a sense of teamwork and cooperation; (6) communicate effectively with people from every socioeconomic, cultural and educational background; (7) exhibit flexibility and cope effectively in an ever-changing, fast-paced healthcare environment; (8) perform effectively when confronted with emergency, critical, or unusual situations; (9) demonstrate the quality work ethic of doing the right thing the right way; and (10) maintain a customer focus and strive to satisfy the customer's perceived needs.

Duties and Responsibilities

New Provider Enrollment:

  • Process the initial PPR packet received from the department for a new provider and enters the data into CACTUS.

  • Obtain any deficient information on the provider from the department contact.

  • Verify all information is in CACTUS, then print the application packet to be sent to the provider for signature.

  • Update the NPPES website with the provider contact information.

  • When the packet is received back from the provider, have Reid Jones sign the necessary pages. Make copies of all applications and required documentation, send the originals to the appropriate payers, and prepare the provider folder for imaging.

  • During the enrollment process, make notes in the contact log in CACTUS regarding correspondence and any actions taken to enroll the provider, and keep up with any dates relevant to the enrollment process on the User Defined and Payers pages in CACTUS.

Enter New Provider Numbers:

  • Upon receipt of a new provider number, the number is entered into CACTUS, IDX, and added to the NPPES website.

  • Indicate the date received or active on the payers page in CACTUS.

Provider Recredentialing or Revalidation:

  • Blue Cross and Medicare providers must be recredentialed every 3 years.

  • The appropriate application must be sent to the provider for signature and then sent to the payer for processing.

  • Documentation of actions and dates must be entered and maintained in CACTUS.

Process Credentialing Related Claim Issues Through ETM

  • Research the ETM task (Audit Trails, Claim Edits, and Third Party Transfers) to determine the issue.

  • Make the necessary contacts and take the appropriate actions to resolve the issue and clear up the AR.

  • Make notes on the ETM task as well as in CACTUS on the contact log.

Follow Up, Correspondence, and Additional Tasks

  • Follow Up in a timely manner on any pending tasks (required documentation, outstanding applications, etc…) and note all follow up attempts in the CACTUS contact log.

  • Respond to all emails and phone messages within 48 hours of receiving the correspondence. Maintain notes of the correspondence in the CACTUS contact log.

  • Additional tasks will be required on a monthly or yearly basis, such as provider terminations and updating provider licenses.

Imaging

  • All paper documentation must be imaged under the appropriate provider number and document type.

  • Provider folders should be imaged prior to receiving the provider number.

  • Once the documents are prepped for imaging, they will be scanned and validated. They will then be subjected to QA by a source outside of credentialing to verify accuracy and clarity of the imaged documents.

  • Documents that have completed the imaging process will be shredded.

Displays initiative and Accepts responsibility

  • Begins assignments without directions.

  • Recognizes the best way to perform job functions.

  • Looks for ways to improve processes and informs management.

  • Performs tasks routinely.

  • Admits mistakes, makes corrections and works to prevent future occurrences.

  • Takes on more work willingly whenever possible.

Reports to work regularly and on-time:

  • Adheres to department’s time and attendance policy.

  • Shows reliability and dedication.

  • High School Diploma or equivalent and basic computer and keyboard skills required.

  • Two years of credentialing experience desired. CPCS preferred.

  • Strong conceptual, as well as quantitative and qualitative analytical skills

  • Work as a member of a team as well as be a self-motivator with ability to work independently

  • Constantly operates a computer and other office equipment to coordinate work

  • Frequently travels by airplane, train or car as necessary to perform work at another location

  • Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data

  • Generally works in an office environment

Navigant Cymetrix is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information or any other basis protected by law, ordinance, or regulation.

Navigant will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.