INSURANCE CREDENTIALING SPECIALIST -TEMPORARY

Insurance Credentialing Specialist - TemporaryHarlingen Clinic - Harlingen, TX 78550DescriptionGeneral description of position: Responsible for the oversight and coordination of credentialing and re-credentialing of all providers and facilities to fulfill government credentialing regulations and are properly enrolled with insurance agencies. Understands specific application requirements for each payer including pre-requisites, forms required, supporting documentation and regulation. Knowledge of provider credentialing and its direct impact on the practice revenue cycle. Great customer service and telephone etiquette, computer knowledge, professional appearance, attention to detail, able to multitask and work in a fast-paced environment. Ability to work well under stress and maintain calm under pressure and work well with team members and willingness to cross-train. Functions as a member of a collaborative health care team to create and maintain a patient centered medical homeEssential Job Functions:Manage the completion and submission of provider enrollment applicationsPerform tracking and follow up to ensure providers, facilities are established timely and linked to appropriate entity.Retain records related to completed enrollment applications.Process applications for providers for re-credentialing with facilities and payers.Responsible for tracking credentialing expiration of facilities and providers with accuracy and timeliness.Works with other staff to streamline and improve processes related to credentialing and provider dataObtains appropriate paperwork, reviews applications, and prepares verification lettersEnsure insurance directories are correct and up to dateUpdate providers/facility CAQH database file timely according to the schedule published by CMSComplete revalidation requests issued by government or insurance payersComplete credentialing applications to add providers to insurance payers.Works closely with supervisor and billing staff to identify and resolve any denials or authorization issues related to credentialing.Maintain accurate provider/facilities profiles on CAQH, PECOS and CMS or any other database.Works on daily correspondence from insurancesResponsible for insurance, provider and EDI set-ups in CentricityResponsible for new and/or amendments for insurance contractsTravels to different clinics to obtain required information needed for credentialing.Other duties assignedTeam Communication: works closely with appropriate staff to resolve issues with the credentialing process to ensure proper deadlines are met. Educates staff on credentialing process and standards as needed.Management of Documentation : Maintains appropriate documentation and reporting regarding the credentialing process (application, DEA, liability insurance, etc) for each provider and facility.Demonstrates Safe Professional Conduct: Maintains a friendly environment for self and others. Refrains from texting and speaking on the cell phone. Refrains from informal communication with patients and others. Fully participates in performance improvement and follows all Clinic policies and procedures. Attends work on a regular and predictable schedule in accordance with clinic leave policy and performs other duties assigned. Submits required documentation in a timely manner.QualificationsKnowledge, skills, and abilities: (use of equipment, job related knowledge, language, etc.)Knowledge of PCMH ModelKnowledge of SC policies and proceduresKnowledge of medical billing practicesKnowledge of ICD-10 and CPT codingKnowledge of computer software (Microsoft Word, Excel, Outlook etc.)Skilled in customer relationsSkilled in the use of a computerSkilled to examine documents for accuracy and completenessSkilled in billing and codingAbility to provide effective customer service on a daily basisAbility of read, write and spell correctlyAbility to maintain and effective and professional working relationship with the public and co-workersAbility to bend, stretch, stoop, stand, sit and lift up to 20 lbsAbility to operate a keyboard, telephone, and other office equipmentAbility to examine documents for accuracy and completenessAbility to prepare records in accordance to detailed instructionsAbility to communicate fluently in English and SpanishAbility to maintain a positive work environmentAbility to work in a fast paced environmentAbility to maintain a flexible work scheduleAbility to maintain client and office confidentialityAbility to fully comply with the enhanced infection control requirements of the clinic.Minimum Qualifications/Certificates/Licenses/Registrations Required:High school or GED. Certified in Medical Office Specialist from an accrediting school or minimum of two years of experience in third party billing and collections and in processing payments on an automated system or, must be familiar with Private Insurance, Medicare and Medicaid claims filing. Experience with CPT and ICD-9 coding.Special instructions: This position requires travel. Employee must provide transportation. If employee operates a personal motor vehicle in the performance of their official duties, the employee must possess a current valid Texas driver's license for the appropriate type of vehicle and Texas Liability insurance.Due to the nature of SC Services, it may be necessary for employees to work extended hours or other variations of the usual shift to ensure adequate care to patients, maintain service to the community and to meet the department needs.