Coordinator, Licensing and Credentialing

McLean, VA, United States

Overview

As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home.

It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

Showing Up Somatus Strong

We foster an inclusive work environment that promotes collaboration and innovation at every level. Our values bring our mission to life and serve as the DNA for every decision we make:

Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.

Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.

Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests.

Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions.

Tenacity: We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners.

Showing Up for You

We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including:

Subsidized, personal healthcare coverage (medical, dental vision)

Flexile PTO

Professional Development, CEU, and Tuition Reimbursement

Curated Wellness Benefits supporting teammates physical and mental well-being

Community engagement opportunities

And more!

The Coordinator Licensing and Credentialing is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.

Responsibilities

Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications.

Maintain internal provider grid to ensure all information is accurate and logins are available.

Update each provider’s CAQH database profile timely according to the schedule published by CMS and other payers.

Apply for and renew annually all provider licenses – Professional, DEA, Controlled Substance.

Complete revalidation requests issued by government payers.

Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.

Complete re-credentialing applications for commercial payers.

Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.

Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

Work closely with the coding and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.

Process initial credentialing and re-credentialing applications.

Screen practitioner applications and supporting documentation to ascertain their eligibility.

Identify discrepancies in information and conduct follow-ups.

Communicate and interact with medical providers, staff, clients, and stakeholders.

Assist with credentialing inquiries.

Respond to health plan provider inquiries.

Capture primary source documentation in computer databases.

Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements, and company credentialing policies.

Ensure credentialing database contains up-to-date information at all times.

Responsible for monitoring credentialing/re-credentialing requirements, as well as required certifications, and to ensure the collection of all required renewal certifications are on file within the required time frame.

Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.

Track compliance with applicable laws, regulations, procedures, and policies.

Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing.

Other duties as assigned.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications

Required Education and Experience

Associate’s Degree+ in Healthcare or Business Administration.

4+ years of credentialing experience with hospital or physician practice medical staff, and/or 4 years experience in a medical practice business office role.

Experience with submitting applications for State, Federal, and Health Plan credentials.

Experience with submitting applications for State, Federal, and Health Plan contracts.

Experience with CAQH (Council for Affordable Quality Healthcare) database and application process.

Knowledge of medical credentialing and privileging procedures and standards and working understanding of the direct impact of credentialing on the organization’s revenue cycle.

Excellent verbal and written communication skills.

Exceptional proficency with Microsoft Office Word, Excel, and PowerPoint.

Proficient touch-typing skills.

Ability to focus for extended periods.

Preferred Education and Experience

NAMSS Certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS).

Working knowledge of credentialing accreditation regulations, policies, and procedures, and NCQA standards also preferred.

Experience with submitting and maintaining Collaborative Agreements between Nurse Practitioners and Physicians.

Knowledge, Skills, and Abilities

Ensures work product demonstrates meticulous attention to detail, accuracy, and completeness.

Ensures Ethical Conduct in all areas of work performance.

Communicates with co-workers, management, vendors, and others in a courteous and professional manner.

Team player with excellent interpersonal skills.

Strong written and verbal communication skills.

Conform with and abide by all regulations, policies, work procedures, and instructions.

Conform with all safety rules and use all appropriate safety equipment.

Incredibly strong organizational capabilities with the ability to pivot quickly to prioritize daily functions and responsibilities.

Ability to ask clarifying questions

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.