What are the responsibilities and job description for the Credentialing Specialist position at Great River Health?
Minimum Hiring Wage:
From $25.14 per hour
Job Details:
Scheduled Hours: Monday - Friday (days)
Job Description:
A Brief Overview
The Credentialing Specialist is responsible for the timely submission of provider enrollment applications to governmental and commercial payers and performing the tracking and follow-up required until providers are established and linked appropriately. Serves as the primary provider enrollment liaison for clinics, payers, billing office, and practitioners.
What you will do
The Credentialing Specialist is responsible for the timely submission of provider enrollment applications to governmental and commercial payers and performing the tracking and follow-up required until providers are established and linked appropriately. Serves as the primary provider enrollment liaison for clinics, payers, billing office, and practitioners.
What you will do
- Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations. Update and maintain all necessary payer credentialing and revalidations for all providers. Interact with providers via phone or email as needed. Participate in the physician onboarding and offboarding processes to ensure accurate practice addresses, taxonomies, and relevant information to ensure maximum reimbursement.
- Reseach provider reimbursement questions and issues. Provide updates to clinic management, coders, and billers regarding reimbursement and/or current provider status or provider reimbursement.
- Complete audits as requested by payers quarterly, biannually, and annually
- Communicate enrollment trends
Qualifications:
Qualifications
- H.S. Diploma or General Education Degree (GED) Required
- Associate’s Degree (AA) Associates Degree in Business, Finance or Healthcare related field or equivalent combination of education and experience in health care field Preferred
- 1-3 years Experience in payer enrollment and credentialing Preferred
- 1-3 years Prior healthcare experience Preferred
- 1-3 years Experience using Microsoft Office products Required
- Excellent interpersonal skills with solid written and oral communication and presentation skills
- Strong keyboarding skills and working knowledge of Microsoft Office (Word/Excel). Technically adept with automated systems, with the knowledge to navigate automated systems efficiently and effectively.
- Knowledge of revenue cycle management and accounting principles effecting reimbursement.
- Assist with implementing and review delegation contracts with payers
- Excellent time management skills with a proven ability to meet deadlines.
- Ability to conduct research and use available resources to reslove issues.
- Ability to succeed in a high-performance environment where client expectations are consistently met or exceeded
- Identify enrollment trends and/or issues communicate to appropriate individuals as needed.
Benefits:
We are excited to offer an aggressive compensation and benefits package for qualifying positions, which includes:
- Competitive base pay
- Matching retirement programs
- Health, Dental and Vision plans
- Health Savings and Flexible Spending Accounts
- Employee discounts including car rental, cell-phone plans
- Employer-paid, Long-Term Disability, Life, and AD&D
- Paid time off (PTO)
- Education Assistance Program
- Employee Assistance Program
- Employee Referral Bonus Program
- Discounted cafeteria meals
- Paid Parental Leave
- Employee Service Recognition program
- Voluntary plans including: Life, AD&D, Short-Term Disability, Critical Illness, Accident, Insurance, and Hospital Indemnity
Great River Health and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Salary : $25
