Position Summary:

Responsible for maintaining and updating the initial credentialing and/or re-credentialing of providers or facilities with third party payers and institutional enrollment requirements for governmental programs for the McLaren Health Care system. Works in collaboration with each facility (subsidiary) or appropriate McLaren department to obtain supporting documentation and information required to meet payers regulatory and compliance requirements for their credentialing and enrollment programs. Facilitates and assists with applicable payers relative to changes of information for provider or facility credentialing and enrollment.

Essential Functions and Responsibilities As Assigned:

1. Prepares and maintains requests for initial credentialing and re-credentialing for facilities or providers.

2. Facilitates and coordinates with appropriate McLaren departments to ensure supporting documents are obtained for completion of initial and re-credentialing applications

3. Researches and keeps abreast of third party and governmental payers’ regulations and changes pertaining to credentialing and enrollment.

4. Collaborate with McLaren Physician Partners, McLaren’s Physician-Hospital Organization (PHO), related to requests for credentialing applications, contracted health plan inquiries, assistance on information requests, etc.

5. Utilize external databases (CHAMPS, CAQH, NPPE, & other payer portals as needed) to complete information needed to submit to payer and update information when necessary.

6. Supports vendors for out of state (OOS) Medicaid claims by collecting supporting documentation & signatures required, if applicable.

7. Maintains enrollment worklist, puts claims on hold until provider is credentialed by the payer, and then releases claims on hold once provider is enrolled with the payer, if applicable.

8. Effectively communicates status of projects, including barriers encountering so resources can be allocated.

9. Effectively communicates with appropriate McLaren Health Care system divisions relative to enrollment and credentialing.

Qualifications:

Required:

• High school diploma or GED

• Two years or more experience in a role related to health care administration pertaining to institutional or provider enrollment, and/or finance role with reimbursement responsibilities.