Credentialing Specialist
About The Position
Principal Responsibilities and Competencies: o Working with Payer Representatives to problem solve ongoing issues and stay educated on any updates from the payer. o Participating in educational activities and staff meetings when necessary. o Credentialing new providers/facilities with all payers o Maintaining providers/facilities credentials and keeping files up to date o Contacting providers/payers when needed to acquire information needed for credentialing purposes o Resolving any credentialing issues o Maintain CAQH updates o Keep up with KY Medicaid portal, PECOS, revalidations for providers and clinics o Revalidations every 3 years with payers o Review payer rosters o Communicate/collaborate with hospital credentialing staff o Maintaining confidentiality and adheres to all hospital policies, including HIPPA guidelines. o Participate in bi-weekly Onboarding meetings o Other duties as assigned. Work Environment: Office setting Physical Demand: Walking, frequent sitting at desk, occasionally stair climbing, occasionally lifting, looking at computer screen, writing. Schedule: Monday through Friday; 40 hours. Travel: Occasionally travels from off site business office to hospital or clinic locations
Requirements
- High School diploma or equivalent (May be allowed to sign a GED agreement to obtain within 6-months)
Nice To Haves
- experience in insurance billing and follow-up and credentialing.
Responsibilities
- Working with Payer Representatives to problem solve ongoing issues and stay educated on any updates from the payer.
- Participating in educational activities and staff meetings when necessary.
- Credentialing new providers/facilities with all payers
- Maintaining providers/facilities credentials and keeping files up to date
- Contacting providers/payers when needed to acquire information needed for credentialing purposes
- Resolving any credentialing issues
- Maintain CAQH updates
- Keep up with KY Medicaid portal, PECOS, revalidations for providers and clinics
- Revalidations every 3 years with payers
- Review payer rosters
- Communicate/collaborate with hospital credentialing staff
- Maintaining confidentiality and adheres to all hospital policies, including HIPPA guidelines.
- Participate in bi-weekly Onboarding meetings
- Other duties as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
Number of Employees
101-250 employees
