Credentialing & Health Insurance Specialist

RightSite Health

6d

About The Position

We are changing how EMS navigates care! RightSite partners with EMS on-site to connect non-emergent patients with a Telehealth ER Provider and navigate them to the right site of care. Patients instantly access an ER Telehealth Provider and a Patient Navigator who provide a trusted, genuine human connection in a time of need. EMS becomes more available for critical emergencies while we deliver higher quality care at a lower cost and better experience for everyone.

The Credentialing and Health Insurance Specialist will be responsible for managing all aspects of the provider licensing and credentialing process including health plan network participation across multiple states. This dynamic role requires a strong understanding of licensing and credentialing, attention to detail, and the ability to work independently as well as collaboratively with other departments. As a crucial member of our team, you will leverage your expertise to optimize revenue cycles, ensure compliance with state and federal regulations, and contribute to the financial health of our organization. Your skills in navigating complex state and federal licensing systems and health plan network systems will be instrumental in maintaining smooth operations.

If you would like the opportunity to make a tangible impact on community health while working for a dynamic, mission-driven organization, we would love to hear from you!

Requirements

• Bachelor’s degree in healthcare administration, business, or related field or equivalent work experience
• Minimum 2 years of experience in provider onboarding
• Proficiency in health plan networks
• Strong knowledge of licensing, credentialing, Medicare and Medicaid
• Familiarity with HIPAA regulations and privacy standards
• Comprehensive knowledge of licensure and credentialing and ability to apply that knowledge to multiple states and provider types. This includes understanding various external regulatory systems, State and Federal requirements, and regulatory compliance.
• Meticulous focus on accuracy when handling provider information, licensure data, and records. This skill is crucial for minimizing errors in licensure and ensuring proper care given to a provider's personal data.
• Ability to analyze complex licensure issues, identify discrepancies, and develop effective solutions. This competency is essential for resolving licensure and credentialing discrepancy, health plan network processes and optimizing revenue by facilitating timely ability to bill for provider services.
• Proficiency in clearly conveying complex licensure/credentialing issues to Operations to include timely notification of effective dates. An important component is the ability to clearly convey the RightSite model to facilitate obtaining FFS contracts.
• Strong aptitude for using and adapting to various billing software, electronic health record systems, and data analysis tools. This competency is vital for managing external systems and improving operational efficiency.

Responsibilities

• New Provider Onboarding: IMLC, Licensure, Medicare, Medicaid, DEA
• Maintenance and Verification on external sites: CAQH, NPPES, PECOS, Availity, etc.
• Provider Renewals: IMLC, Licensure, Nurse Compact
• Health Plans – Applications, follow up, Contracting and Credentialing for FFS
• Health Plan Maintenance - Credentialing
• Health Plan requirements such as specific trainings
• Database and effective date input and management
• Password Management
• Billing Partner support: effective dates, passwords, specific health plan issues
• Policies and Procedures for Physician Credentialing/Contracting
• Communication to Operations to support Provider scheduling

Benefits

• Competitive base salary
• Market-competitive healthcare coverage, including medical, dental, vision, life, and disability
• The opportunity to work alongside talented and professional colleagues with the ability to grow

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level