Credentialing Specialist

Alomere Health • Alexandria, MN

2d • $21 - $30 • Onsite

About The Position

The Credentialing Specialist will be responsible for the accurate and timely processing of Payer enrollments applications and re-applications with insurance companies upon onboarding of Physicians organization wide. The Payer Credentialed will also be responsible for all Facility Enrollments. The Credentialing Specialist is responsible for managing all aspects of Provider payer credentialing process in a manner consistent with hospital and department policies and procedures. The position will be expected to use good judgement in minor decision-making as is related to Credentialing but will not be expected to make major decisions relative to policies. This position will also be responsible for Payer EFT and ERA enrollments.

Requirements

• Five years’ experience working with Payer Credentialing, or in another related field
• Strong computer skills, proficient in MS office
• Knowledge of medical staff and provider privileging requirements and compliance

Nice To Haves

• Medical Billing
• Credentialing Certification

Responsibilities

• Comply with Federal, State, and Local laws related to Payer Credentialing
• Correspond with Providers regarding all processes
• Ensure the completeness of the credentialing appointment and reappointment process by assuring that primary source verification is complete
• Communicate effectively with Department Chairs regarding Provider payer credentialing
• Ensure documentation in Provider files is accurate, and handled appropriately ensuring confidentiality; retaining the records per department policy
• Serve as a resource on all payer credentialing within his/her scope of responsibility
• Insurance/hospital initial payer credentialing/re-credentialing & monitoring hospital-privileging requests.
• Set-up and Maintain on-line credentialing portals for MCC &CAQH
• Renewals – Mn License, DEA, PA delegation agreements
• Work credentialing related insurance denials and other issues
• Provider roster updates for ACO, insurances
• Work with the Revenue Cycle Director on maximizing efficiencies including bringing up new software to aid in the Payer Credentialing Process.
• Enroll payers for EFT and ERA enrollment through Trubridge and Payer portals.
• Perform all other related duties as assigned in a professional and responsive manner
• Demonstrate the ability to use relevant equipment
• Support, understand, and promote Alomere Health’s mission, vision, values, policies and procedures
• Ability to meet the work schedule requirements with flexibility dependent upon the needs of the department
• Foster respectful working relationships with professional colleagues, patients, families, and general public regardless of age, gender, lifestyle, culture, beliefs, race, socioeconomic class, or ability

Benefits

• Health, Dental, and Vision Insurance
• Employee Health Clinic (health +): Our health+ clinic provides office visits and prescription medications for little to no cost to Alomere Health employees and their dependents who are on a medical insurance plan
• Retirement Savings: (401(k)) - All eligible employees of Alomere Health are automatically enrolled. All eligible employees are able to contribute on a pre-tax and/or post-tax basis and Alomere Health matches 100% up to 6% of employee's contributions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed