Credentialing Specialist

Starkey Canada•Eden Prairie, MN

6d•$40,000 - $45,000

About The Position

Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process for a nationwide group of audiology services providers. Facilitates all aspects of credentialing, including initial credentialing, re-credentialing and expirable process. Ensures interpretation and compliance with the accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statutes and regulations relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Credentialing Manager.

Requirements

Associate degree in Health Care or Business Administration preferred
High School diploma or equivalent required
4 years working in a managed care or medical office environment is required.
Understanding of certification requirements.
Basic understanding of NPI maintenance, Medicare, and Medicaid programs, CAQH, etc.
Knowledge of medical credentialing standards.
Ability to communicate effectively and professionally, both orally and in writing, with all levels of internal and external customers.
Program planning and implementation skills to increase efficiencies and productivity.
High degree of accuracy and attention to detail.
Informational research skills, using on-line content, telephone conversations, and printed materials.
Ability to use independent judgment to manage and impart confidential, HIPAA-protected information.
Ability to make administrative/procedural decisions and judgments.

Responsibilities

Coordinate, and monitors the review and analysis of provider applications and accompanying documents, ensuring provider eligibility.
Conduct thorough research and primary source verification using on-line tools and phone calls of all components of the application
Identify issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow
Prepares credentials file for completion and presentation to Credentialing Committees, ensuring file completion within time periods specified.
Process requests for application and payer credentialing
Respond to inquiries from healthcare insurance payers, interfaces with internal and external customers on day-to-day credentialing.
Utilize the credentialing database, optimizing efficiency, and performs query, report, and document generation
Monitor the initial, reappointment and expirable process for all providers, ensuring compliance with department policies and procedures.
Maintain relationship with Insurance payer to obtain correct credentialing process.
Update and send monthly database/roster to payer
Develop processes and reporting tools with TPA payer.
Maintain credentialing/contracting folders in SharePoint to secure true information
Maintain CAQH profile for each provider
Perform miscellaneous job-related other duties as assigned.
Other duties/responsibilities as assigned