Remote

Description

This role is responsible for performing credentialing, re-credentialing and revalidation of all affiliated licensed practitioners and other licensed staff. This position works collaboratively with the billing department and the med staff representative in the credentialing of providers for all payers including Medicare/Medicaid enrollment. The Credentialing Specialist maintains both confidential credentialing files, and an accurate provider database and is also responsible for communication with all licensed providers, billing staff, medical staff coordinator and HR requesting required materials needed, providing timely credentialing updates and statuses with payers.

Requirements

Job Description:

· Creating and maintaining a checklist of all required documents, along with managing and tracking required document requests as they are received

· Determining with each payer the required documents needed to complete the enrollment and credentialing process and requesting accordingly.

· Thoroughly reviewing the payer’s enrollment application, ensuring completion and accuracy before submission.

· Gathering and maintaining provider documents, to include Curriculum Vitae (CV), Proof of Education and Training, License(s), Certification(s), NPI information, Malpractice information, Work history, References, Background check (when applicable)

· Submitting credentialing or re-credentialing packet to payer

· Maintaining confidential credentialing files and provider database (electronically and in physical form)

· Maintaining Athena’s provider enrollment tables

· Maintaining provider database, including adding provider phone number(s), email address(es), pager, provider numbers, appointment/reappointment dates, license expiration dates, registration and/or certification, and credentialing status with insurers

· Communicate with clinical leadership, providers, Billing, HR, and Credentialing staff regarding credentialing / re-credentialing, privileging, and scheduling

· Perform National Practitioner Data Bank queries, check professional liability claims history, and Medicare sanctions on a regular basis (TBD)

· Maintain open communication with the provider, medical staff coordinator and administration to identify issues and ways to resolve credentialing issues as they arise.

· Act as a liaison between the providers, billing staff, medical staff coordinator and operations staff in communicating enrollment status

· Assist billing and patient queries on eligibility, benefits, network status and contract alignment

· Training in Athena’s billing practices to act as an internal billing liaison on claim audits

· Assist in working assigned escalated claims from the billing work queue to mediate denials, insurance refunds and administrative appeals

· Preparing monthly reports and aids with Athena data and payer statuses

· Adhere to organizational policies, procedures, and protocols.

· Perform other duties as assigned by management

REQUIRED QUALIFICATIONS

· High school diploma or equivalency

· Able to communicate effectively in English, both verbally and in writing

· Good interpersonal skills dealing with patients, visitors, and employees.

· Clerical skills include filing and typing with high levels of accuracy.

· Basic to Intermediate Math Skills

· Excellent organizational and time management skills

· Basic to Intermediate computer skills in spreadsheets and word programs

PREFERRED QUALIFICATIONS

· Experience working in a healthcare environment

· A thorough understanding of CAH & RHC billing applications

· 10 years of experience in a healthcare billing position

· Additional language skills – Spanish preferred

· 10 key data entry

· Typing speed 30-40 wpm

Teton Valley Health jobs

Part Time Credentialing, Enrollment & Benefit Specialist