Credentialing Specialist- Medical Payer

HEALTH POINT FAMILY CARE INC • Florence, KY

2d • Onsite

About The Position

HealthPoint Family Care is a private medical practice dedicated to patient wellness, providing adult and pediatric medical, dental, mental health, substance abuse treatment, obstetrics and gynecology, and vision services. They offer walk-ins, same day appointments, evening and weekend hours across locations in Northern and Central Kentucky. The organization is looking to add an additional Credentialing Specialist to its growing team.

Requirements

• One year of experience in direct credentialing including primary source verification and completion of Medicare/Medicaid/commercial payer and hospital privileging applications.
• Knowledge of Ohio and Kentucky Medicaid and Medicare credentialing requirements and systems.
• Proven methods for file maintenance and tracking required.
• Must be professional and detail oriented.
• Strong verbal and written communication skills.
• Intermediate level skills required in Microsoft Outlook, Word and Excel.

Nice To Haves

• Training in medical billing or a related field a plus

Responsibilities

• Accurately tracks, records and collects necessary data from various sources to complete applications, renewals, revalidations and terminations.
• Responsible for coordinating the credential processes practitioners and facility in our growing healthcare practices.
• Maintains Provider credentialing files, initiates NPDB database inquiries, maintains NPPES and CAQH provider databases, and timely completion of Provider enrollment applications.
• Credential providers and facilities with Medicare, Kentucky and Ohio Medicaid and private payers for medical, mental health, women's health, dental and vision services.
• Tracks application status through timely follow-up to ensure enrollment.
• Responsible for processing of provider payor applications, initial, re-applications and attestations.
• Understands Medicare, Medicaid and commercial payor application process and EDI agreements.
• Maintain Credentialing files (paper and computer)
• Coordinates and participates in all phases of credentialing/re-credentialing profile process.
• Tracks and logs credentialing status routinely with participating networks.
• Review, update, maintain and report fee schedule for various payors within Group assigned.
• Aggressively collects, coordinates, reviews and documents performance data, which includes quality and utilization activities, member complaint data for re-credentialing purposes.
• Revenue Cycle projects as assigned.

Benefits

• Retention bonus of $1,500 paid at 18 month of employment
• Additional retention bonus's up to $4,000
• Two free sets of HealthPoint scrubs
• Tuition Reimbursement for up to $1,000 a year.
• Nine paid federal holidays
• Birthday off paid in addition and not counted towards PTO
• Generous Paid Time Off
• Wide array of benefit plans such as health, dental, vision, flexible spending accounts, Safe Harbor 401K Plan, long term disability and group/voluntary life insurance plans.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees