What are the responsibilities and job description for the Credentialing Specialist position at CENTERS FOR PAIN CONTROL?
Job Details
Description
The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.Reporting to and in conjunction with the Revenue Cycle Manager, the Credentialing Specialist will work closely with the RCM to define objectives and maintain credentialing activities.
ACCOUNTABILITIES AND JOB ACTIVITIES:
- Responsible for Credentialing Process of Facilities and Practitioners with payors
- Responsible for Hospital credentialing
- Responsible for following up on credentialing status’
- Responsible for reporting credentialing status and delays to the manager
- Responsible for keeping EMR credentialing up to date
- Responsible for Revalidation of Facilities and Practitioners with payors
- Responsible for reporting revalidation status, obstacles, or delays to the manager
- Act as a primary contact for all depositions and deposition requests
- Maintain status tracking for depositions
- Responsible for insurance grievances
- Responsible for tracking, pulling records, and submitting internal and payer audits
- Responsible for sorting and distributing mail to appropriate sites
- Manage personal work queues timely and effectively
- Attend and contribute to billing staff meetings and huddles
- Perform all other duties as assigned
Qualifications
JOB REQUIREMENTS
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COMPETENT LEVEL QUALIFICATIONS |
MINIMUM LEVEL QUALIFICATIONS |
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SKILLS (Typing and special machinery) |
-Knowledge of Electronic Medical Record -Good typing skills -Good internet navigation skills |
-Knowledge of instrumentation used in office (fax, credit card, copy) -Basic computer skills -Knowledge of the internet -Knowledge of multi-line phone system -Excellent Verbal and Written Communication skills -Knowledge of medical terminology with a strong focus on the spine and skeletal system - Willingness to share knowledge with team members and department leaders throughout the organization |
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EDUCATION AND EXPERIENCE (Degrees, years in profession) |
-7 years of medical practice billing experience within the last 2 years in a medical billing leadership role |
-5 years of medical practice billing experience - Knowledge of the entire physician revenue cycle and its relation to each department |
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CERTIFICATIONS |
N/A |
N/A |
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Special Job Characteristics |
-Fast paced work environment with established time constraints -Must be able to work overtime when required -Must be able to multitask while maintaining accuracy -Must work well with others |
