Credentialing Specialist HCS

Salary : 24.52-36.78 USD

Facility : Administrative Regional Training Cntr

Shift : Shift 1

Status : Full Time FTE : 1.066667

Bargaining Unit : Catholic Health Emmaus

Exempt from Overtime : Exempt : No

Work Schedule : Days

Hours :

Standard work schedule : 8 : 00 am - 4 : 30 pm M - F

Summary :

The Credentialing Specialist is responsible for assisting with the process of electronic credentialing and enrolling them into insurances that are relevant to CHS. Communicate with provider's staff and insurances. This requires electronic collection, processing and organizing significant amounts of enrollment data. Oversee the credentialing process in its entirety from start to finish.

Responsibilities : EDUCATION

A.A.S. Degree or equivalent certificate program required

In lieu of an Associate's degree, a minimum of three (3) years of direct credentialing experience required

EXPERIENCE

Three (3) years of experience in a health care related field

Web based credentialing and privileging software experience preferred

Experience with Physician credentialing strongly preferred

KNOWLEDGE, SKILL AND ABILITY

Strong Microsoft Office skills, knowledge of Word, Excel, Outlook, Adobe Acrobat knowledge

Strong critical thinking skills

Must have a high degree of integrity that is aligned with the values of the organization

Ability to multitask

Strong communication skills, both oral and written

Ability to establish priorities and ability to work well under pressure

Ability to provide work of high quality and accuracy

Resourceful with strong research skills

Strong interpersonal skills

Good judgment, common sense and diplomacy

Solid organizational skills

Ability to work independently

Ability to analyze data and prepare meaningful reports

Ability to identify, react, and follow through in an appropriate manner in credentialing matters

Must remain confidential on all Medical Staff matters

Create individual and group NPIs as needed

Create group contracts with insurance companies for physician practices

Correspond with practitioners to sign applications and receive credentialing documents

Update and attest CAQH on a regular basis

Request annual COI from clients and upload into CAQH

Complete Medicare and Medicaid re-validations when needed

Track when Medicare and Medicaid re-validations are needed

Submit completed payer applications to insurance payers

Follow up with insurance payers to ensure credentialing is moving forward

Create & maintain provider's CAQH

Remind practitioners of expiring DEA / Licensure

Submit current DEA / Licensure to payers and CAQH as needed

Team Player, assisting coworkers when needed

Maintain updated documents and changes within the insurance Portals

Obtain affiliation with Nursing Homes and hospitals for providers

Apply for Malpractice for providers, approve invoices for payment

Provide rosters to insurance companies as needed

Maintain provider CME information, when requested

Travel to obtain signatures from providers when applicable as well as travel to pick up or drop of pertinent paperwork

Handle incoming and outgoing phone call from Insurances, providers, client managers, practice and billing staff

Respond to numerous emails from clients, insurances, office and billing staff

Research requests from office and billing staff regarding claim denials, provider out-of-network issues, etc.

Updates to provider initial credentialing with location updates, name changes, etc.

WORKING CONDITIONS :

Normal heat, light space, and safe working environment; typical of most office jobs

Individual may be required to travel to other CH facilities for staff meetings / staff training

REQNUMBER : 39904