Credentialing Specialist

The Credentialing Specialist is primarily responsible for activities impacting facility and practitioner external provider enrollment and credentialing; this includes all network application and maintenance processes that impact facilities and applicable practitioners employed or contracted by Rogers Memorial Hospital, Inc. In all activities, the Credentialing Specialist must remain aware of and comply with legal, regulatory, and financial policies and procedures. The Credentialing Specialist is in regular contact with payer strategies, medical office staff, financial services, physicians/ practitioners, and contracted payer staff. The Credentialing Specialist is responsible for maintaining up-to-date file information on payer enrolled practitioners in multiple systems, answering inquiries regarding a provider’s network status, and collaborating with colleagues to ensure the accuracy of facility contracted networks and affiliations. The candidate must live in one the following states: Provider Enrollment Application Processing Maintain understanding of RBH Privacy Practices, HIPAA, Medical Staff standards, state and federal= requirements, and other applicable corporate and departmental policies. Responsible for facility and practitioner enrollment activities, maintaining up to date file information in multiple systems, answering inquiries related to network status, collaborating with colleagues to ensure accuracy of facility contracted networks and affiliations Recommend policy and procedural updates as applicable Maintain standard outreach to on-boarding medical staff providers detailing initial and ongoing provider= enrollment requirements Maintain knowledge of all data and document locations required as part of the enrollment process Maintain knowledge of standard work detailing contracted payer provider credentialing processes for all exclusive contracts. Populate and maintain both facility and provider level information in the CAQH system Enroll and maintain facilities and practitioners in all appropriate contracted health plans Enroll practitioners with government payers using electronic application methods such as PECOS and portals Populate credentialing software with timely and accurate provider status and affiliation information Monitor and disseminate affiliation, application and revalidation status upon request and as applicable Patient Financial Services _ Internal Establish and maintain positive and cooperative working relationship with all Patient Financial Services team= professionals Populate and maintain Symplr Provider information referenced by PFS staff to investigate and appeal= professional claim denials Respond to all applicable payer outreach for information and/or clarification Complete projects as assigned by Credentialing Manager Regular assistance with and dissemination of payer communications impacting other departments Participate in process improvement events and activities Serve as a back-up to other Payer Strategies positions on an as-needed basis. Administrative skills, including computer/word processing Computer proficiency, adaptability and working knowledge of Microsoft Office, Adobe and Excel Ability to perform all essential job functions either on site or remotely Working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards General understanding of health insurance plans, provider enrollment processes, payer contracting and remittance processes, and HIPAA and healthcare compliance Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment Experience with CAQH (Council for Affordable Quality Healthcare) database and application process Prior professional history in a medical or mental health setting NAMSS/CPCS Certification Health, dental, and vision insurance coverage for you and your family

• 401(k) retirement plan
• Life/disability insurance
• Flex spending accounts
• Tuition reimbursement
• Employee assistance program (EAP)