Credentialing Specialist- Medical Payer

Credentialing Specialist- Medical Payer

HealthPoint Family Care is currently hiring to add an additional credentialing specialist to the team.

Position Type: Full Time Job Shift: Day Education Level: High School Category: Admin - Clerical

Description

HealthPoint Family Care is currently hiring to add an additional credentialing specialist to the team. The position offers a retention bonus of $1,500 paid at 18 months of employment, with additional retention bonuses up to $4,000. Benefits include two free sets of HealthPoint scrubs, tuition reimbursement for up to $1,000 a year, nine paid federal holidays, a birthday off paid in addition and not counted towards PTO, generous paid time off, and a wide array of benefit plans such as health, dental, vision, flexible spending accounts, Safe Harbor 401K Plan, long term disability, and group/voluntary life insurance plans.

Responsibilities

• Accurately tracks, records and collects necessary data from various sources to complete applications, renewals, revalidations and terminations.
• Responsible for coordinating the credential processes practitioners and facility in our growing healthcare practices.
• Maintains Provider credentialing files, initiates NPDB database inquiries, maintains NPPES and CAQH provider databases, and timely completion of Provider enrollment applications.
• Credential providers and facilities with Medicare, Kentucky and Ohio Medicaid and private payers for medical, mental health, women's health, dental and vision services.
• Tracks application status through timely follow-up to ensure enrollment.
• Responsible for processing of provider payor applications, initial, re-applications and attestations.
• Understands Medicare, Medicaid and commercial payor application process and EDI agreements.
• Maintain Credentialing files (paper and computer)
• Coordinates and participates in all phases of credentialing/re-credentialing profile process.
• Tracks and logs credentialing status routinely with participating networks.
• Review, update, maintain and report fee schedule for various payors within Group assigned.
• Aggressively collects, coordinates, reviews and documents performance data, which includes quality and utilization activities, member complaint data for re-credentialing purposes.
• Revenue Cycle projects as assigned.

Qualifications

• One year of experience in direct credentialing including primary source verification and completion of Medicare/Medicaid/commercial payer and hospital privileging applications. Applicants with less than one year experience will be considered with a training plan.
• Knowledge of Ohio and Kentucky Medicaid and Medicare credentialing requirements and systems.
• Proven methods for file maintenance and tracking required.
• Must be professional and detail oriented.
• Strong verbal and written communication skills.
• Intermediate level skills required in Microsoft Outlook, Word and Excel.
• Training in medical billing or a related field a plus