Credentialing Specialist

Payer Credentialing Coordinator

Performs payer credentialing activities by completing government and payer mandated documentation and data required to enroll, revalidate and/or update changes for all Med Center Health facilities, physician practices, and individual providers. Coordinates onboarding activities with the Medical Staff office, practice managers, and executives to efficiently prepare applications for new/existing providers as well as facilities that become acquired by Med Center Health. Works directly with payer representatives for application acceptance, follow-up and denials due to loading issues. Collaborates with CFR leadership to coordinate timely billing, and communicates payer load completion to practice managers/facility administrators for patient care purposes. Facilitates demonstration of compliance for billing and collection of all government and non-government payers.

Minimum Qualifications

Work Experience:

One year of payer credentialing activities experience required.

Education:

Bachelor's degree in business, health care administration or related field, or equivalent education and experience required.

Certifications/Licensure:

None required.

Job Specific Performance Standards

The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time:

• Coordinates, processes and follows up on payer provider enrollment paperwork for new providers including facilities, physician practices, physicians, APRNs, Physician Assistants, LCSW's, Psychiatrists, Dieticians, and Dentists. Completes provider enrollment paperwork prior to deadlines to avoid a cash flow impact.
• Ensures required fees are paid and tracks corporate credit card expense statements monthly. Prepares and sends statements to accounting for all fees paid.
• Verifies and completes payer revalidations for all providers/facilities as requested by various payers.
• Verifies and completes credentialing in Council for Affordable Quality Healthcare (CAQH) database for all providers.
• Maintains calendar of due dates for licensures, revalidations, CAQH, out of state Medicaid, facility credentialing, certificates of insurance and W9s.
• Responds to telephone requests and distributes messages as needed. Reviews and responds to incoming correspondence.
• Assists and serves as back up of payroll reports for errors and corrections.
• Completes and passes the insurance certification program. Completes number of CEU's necessary to maintain current certification.