CME - Credentialing Spec

DRISCOLL HEALTH PLAN•Corpus Christi, TX

About The Position

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. The CME Credentialing specialist will oversee the credentialing matrix and assist with progress to get providers credentialed with Government payor first. She will be a liaison to administrative assistants as well as providers with regards to the accurate and complete credentialing and revalidation process to ensure the financial viability of the organization in accordance with State & Federal reimbursement guidelines. She will also assist with credentialing commercial insurance carriers for all providers within CPSST practicing. Duties include but are not limited to ensuring accurate and timely update of addresses with payors. Enroll providers into Medicare, Medicaid and commercial insurance plans under CPSST and do revalidations to include updating locations and documentation. Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; the employee will perform other reasonably related business duties as assigned by the immediate supervisor and/or administration as required. Always maintains utmost level of confidentiality. Adheres to DCH policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Review documents submitted by providers (doctors and NP’s) for accurate information. Assist Provider with credentialing revalidations as needed for CPSST providers. Interact with CBO Director and Coding Manager frequently or as needed to ensure compliance and accuracy in credentialing role. Follow up with CBO Director and coding manager on problems and delays in credentialing. Direct report to CBO Manager regarding job responsibilities/functions and DCH policies. Interacts with providers Demonstrates understanding of security and confidentiality of data and information. Always maintains a professional demeanor. Assists in training of other team members and acts as a resource for other staff members. Maintains flexibility in scheduling to ensure optimal departmental operations. Effectively demonstrates DCH philosophy, values, and mission as evidenced by interactions with others. Maintains and ensures confidentiality of financial patient records and follows HIPPA regulations. Performs assignments and other work-related tasks as designated in a timely and professional manner. Responds to all inquiries in a timely and professional manner. Perform any other duty as assigned by the Director or Manager. Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.

Requirements

High school diploma or general education degree (GED)
Three or more years of related work experience in credentialing process

Responsibilities

Oversee the credentialing matrix and assist with progress to get providers credentialed with Government payor first.
Be a liaison to administrative assistants as well as providers with regards to the accurate and complete credentialing and revalidation process to ensure the financial viability of the organization in accordance with State & Federal reimbursement guidelines.
Assist with credentialing commercial insurance carriers for all providers within CPSST practicing.
Ensure accurate and timely update of addresses with payors.
Enroll providers into Medicare, Medicaid and commercial insurance plans under CPSST and do revalidations to include updating locations and documentation.
Review documents submitted by providers (doctors and NP’s) for accurate information.
Assist Provider with credentialing revalidations as needed for CPSST providers.
Interact with CBO Director and Coding Manager frequently or as needed to ensure compliance and accuracy in credentialing role.
Follow up with CBO Director and coding manager on problems and delays in credentialing.
Direct report to CBO Manager regarding job responsibilities/functions and DCH policies.
Interacts with providers
Demonstrates understanding of security and confidentiality of data and information.
Always maintains a professional demeanor.
Assists in training of other team members and acts as a resource for other staff members.
Maintains flexibility in scheduling to ensure optimal departmental operations.
Effectively demonstrates DCH philosophy, values, and mission as evidenced by interactions with others.
Maintains and ensures confidentiality of financial patient records and follows HIPPA regulations.
Performs assignments and other work-related tasks as designated in a timely and professional manner.
Responds to all inquiries in a timely and professional manner.
Perform any other duty as assigned by the Director or Manager.