Credentialing Specialist Physician Billing (13409)

CULLMAN REGIONAL • Cullman, AL

1d • Onsite

About The Position

Responsible for credentialing and maintaining high quality and accurate information for new and established healthcare providers in a timely manner per the Medical Staff policies and procedures. Process and maintain credentialing and re-credentialing in accordance with Medical Staff policy and procedure, Joint Commission standards, State and Federal Regulatory regulations. Identify and evaluate potential red flags and work in collaboration with practitioner to document the issue and physician response. Ensure provider enrollment and maintenance with CAQH and PECOS. Responsible for payor enrollment and re-enrollment to assure claim acceptance. Coordinate with Medical Staff credentialing to obtain information and avoid duplication of efforts. Demonstrates and encourages team behavior and exceptional patient/guest experiences. Upholds and promotes patient safety and quality. Fulfills duties of a Billing Specialist in accordance with provider and/or clinic assignment.

Requirements

• High school diploma required.
• Minimum 1 year in healthcare credentialing preferred or Certified Professional Credentialing Specialist required in lieu of experience.
• 3-5 years in healthcare/medical office preferred.
• Advanced proficiency in Microsoft Outlook, Excel, and Word.
• Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail.
• Very strong interpersonal skills and the ability to build relationships with physicians, staff, and board members.
• Expert level written and verbal communication skills with ability to communicate clearly and concisely.
• Proven ability to handle confidential information with discretion, be adaptable to various competing demands, and demonstrate the highest level of customer/client service and response.
• Capable and comfortable dealing with sensitive and confidential information with discretion and trust.
• Able to work well under tight deadlines and respond to rapidly changing demands while providing efficient follow-up.
• Able to work with minimal supervision and work well in both individual and group environments.

Nice To Haves

• Associate's degree preferred.
• Certified Professional Credentialing Specialist (CPCS) desirable.
• Experience with CPSI and Cerner preferred.

Responsibilities

• Responsible for credentialing and maintaining high quality and accurate information for new and established healthcare providers in a timely manner per the Medical Staff policies and procedures.
• Process and maintain credentialing and re-credentialing in accordance with Medical Staff policy and procedure, Joint Commission standards, State and Federal Regulatory regulations.
• Identify and evaluate potential red flags and work in collaboration with practitioner to document the issue and physician response.
• Ensure provider enrollment and maintenance with CAQH and PECOS.
• Responsible for payor enrollment and re-enrollment to assure claim acceptance.
• Coordinate with Medical Staff credentialing to obtain information and avoid duplication of efforts.
• Demonstrates and encourages team behavior and exceptional patient/guest experiences.
• Upholds and promotes patient safety and quality.
• Fulfills duties of a Billing Specialist in accordance with provider and/or clinic assignment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED