Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Credentialing Managed Care Coordinator for our office in Norfolk.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Credentials and re-credentials providers according to quality standards and company policies and procedures. Notifies providers of licensure expirations and submits licensure applications and renewal forms with payment to State agencies and appropriate departments. Recommends process improvements.
Maintains current provider licensure files and provides information to hospitals and other healthcare providers as appropriate. Requests and completes hospital credentialing and privileges applications for providers.
Obtains and maintains provider participation in managed care plans in a timely manner and communicates information to practice sites and business office.
May implement and maintain the contract management system to include terms of the contract, providers credentialed to the payer and other contracted service providers (labs, hospitals).
May complete EOB analyses or fee schedule variance reporting on a monthly basis for the top Managed Care payers according to policy and procedure. May produce monthly managed care reports and implement new analysis tools to assist in reporting functions.
May maintain expected reimbursement by CPT code for the top payer contracts in each market and communicate changes to system librarian.
May develop and provide maintenance of proformas for all contracts.
Supports Network Contracting Representative/Manager in general administrative functions.
Trains junior and practice staff with respect to credentialing contracts, policies and procedures.
Other duties as requested or assigned.
High school diploma or equivalent required.
Technical certification or Associates Degree a plus.
At least five (5) years of credentialing related work experience required.
Proficiency with computer systems and MicroSoft (Office Outlook, Word, Power Point, and Excel) required.
CPCS certification is preferred.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Internal Number: MCKEA00878032
About New York Oncology Hematology
New York Oncology Hematology (NYOH) is the leading provider of community-based cancer care and blood disorder services. With seven convenient locations in Albany, Amsterdam, Clifton Park in Saratoga County, Hudson, Rexford and Troy, our team of 32 physicians and 350 cancer care specialists see more than 100,000 cancer visits a year.
NYOH has always been at the forefront of cancer care. More than 30 years ago, we began as the region’s first oncology practice in a community setting (outside a hospital). A few years later, we offered the first radiation treatment outside a hospital setting.
Today, we continue our commitment of providing world class care, close to home. We offer the region’s largest clinical research and drug trial operation, only stem cell transplant program and only neuro-oncology care. We recently brought the first Varian Truebeam Radiotherapy System to our new practice: Clifton Park in Saratoga County.
Our medical staff includes 32 board certified physicians who specialize in the care of patients with cancer (medical oncology and radiation oncology) and blood-related disorders (hematology). With a patient care team of more than 350 oncology certified nurse...s, pharmacists, laboratory technologists, radiation therapists and support personnel, we are able to provide the personal level of care our patients need during treatment.