What are the responsibilities and job description for the Credentialing Specialist position at orthotalent?
Facility: OrthoIndy Northwest, Indianapolis, IN
Department: Credentialing
Shift Details: Exempt, 40 hours per week
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General Statement of Duties
The Payer Enrollment Coordinator directs the processing of applications, appointments, and administrative support services for physicians and non-physician practitioners. The Coordinator works very closely with various departments to ensure proper communication regarding aspects of payer enrollment of new providers. The Coordinator assists with the maintenance of OrthoIndy Hospital privileges, insurance contracts, state licensure, and malpractice insurance. The Coordinator oversees all OrthoIndy provider credentialing applications and answers any questions regarding credentialing and is responsible for follow up and research of payer issues that arise due to insurance and paperwork errors.
Essential Duties:
- Advises and maintains the application processes for Indiana licensing and certification for OrthoIndy physicians and non-physician practitioners, hospital privileges as requested, participation in insurance plans, recredentialing for insurance providers and reappointment for facilities. Tracks and follows-up on applications. Obtains and provides all requested documents and information to complete applications. Coordinates with other staff to ensure compliance for application processing. Provides guidance and recommendations to applicants and prospective candidates.
- Coordinates compliance with overall expirable processing including initial, continuing, and renewal credentialing. Understands the risk of missed documentations and follows-up accordingly. Tracks documents capable of expiring and updates the credentialing system and the electronic file.
- Initiates payer enrollment process and ensures applications are submitted as timely as possible. Researches payer billing issues and ensures resolution is communicated appropriately, including ongoing maintenance of payer websites related to provider information.
- Initiates credentialing of fellows. Determines if the provider is eligible to bill, and if so, initiates the payer enrollment process. Works closely with the OrthoIndy Research Foundation to ensure a smooth transition to the fellowship.
- Screens the Council for Affordable Quality Healthcare (CAQH) online credentialing accounts and updates as needed.
- Manages the medical staff electronic credentialing system.
- Assists with tracking all provider continuing medical education (CME) hours and enters into credentialing system.
- Processes malpractice applications for new or renewed OrthoIndy physicians and non-physician practitioners.
- Audits payer directories and submits corrections to health plans. Ensures data is correctly entered into the database and runs regular audit reports to catch discrepancies. Writes and edits reports in additional software, including Crystal.
- Answers questions, issues and provides detailed information on requirements, processes, and policies. Collects information and qualifying candidates for programs, services or courses.
Requirements:
- Bachelor's Degree in related field required; or experience beyond requirements
- Certified Provider Credentialing Specialist certification required within 3-4 years of hire date
- 4-6 years of related experience required; 8-10 years of experience preferred
OrthoIndy is an Equal Opportunity Employer
