Provider Relations & Credentialing Coordinator

Nexus is currently seeking to fill a Provider Relations & Credentialing Coordinator position at our corporate headquarters in New Braunfels, Texas. This role is an amazing opportunity to grow and diversify your career within the healthcare arena. If you are interested in joining the Nexus team, access our application here.

Employee Application

WHAT WE LOOK FOR:
Ideal candidate is a highly motivated and dynamic individual that thrives in a fast paced environment.

POSITION OVERVIEW:

Title:  Provider Relations & Credentialing Coordinator

Job Summary
This position is responsible for facilitating the credentialing, orientation process and communication of our contracted physicians, allied health professionals, physician assistants, and nurse practitioners through an organized and systematic routine.

 Essential Job Functions

  • Effectively work in tandem with the Nexus Marketing Department and continuously corresponds, verbally and through email communication with physicians and allied health professionals as their contract information is disbursed from the Nexus Marketing Team.
  • Communicate promptly (verbally and through email) sending essential Nexus forms to physicians initiating the credentialing process
  • Directly responsible for receiving, organizing, and documenting all needed credentialing documents of contracted physicians and allied health professionals.
  • Effectively oversee the expiration of all documents and maintaining communication to ensure all licenses/documentation are kept current.
  • Works closely with Nexus clients and will be responsible for providing them with updated information, changes of information, and the credentialing materials for any new physicians and/or allied health professionals.
  • Maintain and update physician files by properly saving all physician/allied health providers’ documents in the correct format
  • Maintain and update “Doctor Birthday Calendar” with dates of physician/allied health professionals’ birthdays; communicate with VP of Operations/Operations Managers
  • Conduct physician orientation calls for newly credentialed physicians entering the Nexus panel
  • Update and maintaining crucial intra-office documents which inform the operations staff of the demographic information of our panel of physicians and allied health professionals.
  • Responsible for organizing, facilitating, and initiating a routine credentialing meeting in which new physicians and allied health professionals will be introduced, discussed, and either approved or denied based upon objective criteria.
  • Communicate (verbally and through email), in advance, to remind physicians of their expired documents
  • Supply clients with physician information as requested, while also keeping them updated with any newly-renewed documents
  • Coordinate with various client contacts to quickly and accurately perform updates and changes necessary in their respective credentialing documents/processes
  • Maintain an organized filing system in Outlook to quickly access physician communication
  • Work with the Medical Director, VP of Operations and Director of Operations to relay communication to contracted Nexus panel members individually and as a whole
  • Work with the Medical Director, VP of Operations and Director of Operations to provide monthly analytic reports quantifying quality barometers of Nexus panel members
  • Creation and Updating of the Nexus panel member handbooks and orientation documentation.
  • Analytically and structurally seek out inconsistencies in paperwork or written/verbal communication, and work quickly to rectify them
  • Maintain and update “Active Full Panel List” as physicians are added or removed from panel by utilizing the key to differentiate status
  • Utilize “Active Full Panel List” as a reference for all the physicians (by states/by specialties) that are on panel
  • Maintain and update “Credentialed Doctor Database” as physicians credentialing documents are submitted to each of Nexus’ clients
  • Maintain and update “Contacting Southeast/Southwest Doctors” spreadsheet as physicians have completed their orientations
  • Maintain, update, and utilize the “Active Credentialing Report” to maintain a record of communication with newly recruited, pending approval, and pending orientation physicians and allied health professionals
  • Provide an up-to-date version of this report for every individual present at each Credentialing Meeting
  • Maintain, update and utilize the “Active Credentialing Checklist” to keep track of documents that have been received and are awaiting receipt from physicians and allied health professionals initiating the credentialing process
  • Have a keen eye for identifying and correcting formatting issues and typographical errors promptly
  • Update all intra-office panel lists when new physicians are added to the panel
  • Communicate with operational managers, marketing, and the bookkeeping departments after an orientation has been conducted to ensure addresses, names, and billing information is shared promptly
  • Track physician referrals and notify appropriate operations staff when assessment of referral fee payment eligibility should be undertaken
  • Utilize the documents saved in each physician/allied health professionals’ folder as reference for completing credentialing applications
  • Complete all credentialing applications by providing accurate and clearly written information for each physician and allied health professional after they have been approved at the credentialing meeting
  • Contribute to the team effort by accomplishing related tasks as needed by the Marketing, Operational, Management, and/or Bookkeeping Departments

Knowledge and Abilities Requirements:

  • Ability to identify trends through analysis of monthly reporting of Nexus panel and provide recommendations/solutions in communication and training
  • Ability to make recommendations for credentialing/orientation process to improve the efforts of the department
  • Excellent relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness
  • Strong professional level of knowledge of the UR industry and comprehensive assessment skills
  • Demonstrated ability to problem solve complex, multifaceted situations
  • Ability to engage easily in abstract thought
  • Strong organizational and task prioritization skills
  • Knowledgeable of multi state workers’ compensation systems
  • Computer literacy on Microsoft Office products and data base programs
  • Ability to construct grammatically correct reports using standard medical terminology

 Education and Experience:

  • Bachelor’s or Associates Degree preferred, but not required
  • Prior UR Administrative support experience preferred
  • Minimum of 2 years experience in multi-task driven work environment, requiring high level organization skills

License and Certification:

  • Certified Provide Credentialing Specialist (CPCS) (willing to obtain)
  • Institute for Credentialing Excellence (ICE) Credentialing Specialist (willing to ob