What are the responsibilities and job description for the Credentialing Specialist - Richmond- Hybrid position at Dominion Care?
ESSENTIAL DUTIES and RESPONSIBILITIES
Maintains confidentiality in compliance with HIPAA regulations for all client PHI.
Accurately complete credentialing and reappointment applications to be sent to payers and facilities on behalf of providers.
Track progress of outstanding applications and report progress to Billing Manager, LOB Directors and Providers.
Keep current provider records electronically in Credentialing software, electronic provider folders, and in provider hard copy folders.
Assist in obtaining needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificate of insurance, etc.
Prepare professional communication to providers, payers, and facilities.
Understand how provider credentialing impacts billing, contracts, and EDI.
Investigate solutions to problems and determine the best course of action.
Communicate clearly and professionally with team members, providers, payers, facility credentialing representatives, Client Managers, and Team Leaders.
Investigate unpaid and denied claims related to Credentialing/Provider contract issues.
To perform this job successfully, an individual should have knowledge of Spreadsheet software and Word Processing software.
Physical Demands: Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to talk or hear. The employee is frequently required to walk, sit, use hands/fingers to touch, handle and/or reach with hands and arms. The employee is occasionally required to stand and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work Environment: Behaves professionally and supportively when working with individuals from a variety of ethnic, social and educational backgrounds.
Preferred Education and Experience
High School Diploma or equivalent.
Knowledge of Behavioral health clinical services preferred.
2-3 years of experience working in medical/healthcare Credentialing.
Deep knowledge and understanding of Payer Contracts, CAQH, Insurance web portals, EHR systems, etc...
Strong ability to communicate effectively and timely with Management, Clinicians and payors in person, over the telephone, and in writing.
