INSURANCE CREDENTIALING SPECIALIST -TEMPORARY

SU CLINICA FAMILIAR•Harlingen, TX

4d•Onsite

About The Position

Responsible for the oversight and coordination of credentialing and re-credentialing of all providers and facilities to fulfill government credentialing regulations and are properly enrolled with insurance agencies. Understands specific application requirements for each payer including pre-requisites, forms required, supporting documentation and regulation. Knowledge of provider credentialing and its direct impact on the practice revenue cycle. Great customer service and telephone etiquette, computer knowledge, professional appearance, attention to detail, able to multitask and work in a fast-paced environment. Ability to work well under stress and maintain calm under pressure and work well with team members and willingness to cross-train. Functions as a member of a collaborative health care team to create and maintain a patient centered medical home.

Requirements

Knowledge of PCMH Model
Knowledge of SC policies and procedures
Knowledge of medical billing practices
Knowledge of ICD-10 and CPT coding
Knowledge of computer software (Microsoft Word, Excel, Outlook etc.)
Skilled in customer relations
Skilled in the use of a computer
Skilled to examine documents for accuracy and completeness
Skilled in billing and coding
Ability to provide effective customer service on a daily basis
Ability of read, write and spell correctly
Ability to maintain and effective and professional working relationship with the public and co-workers
Ability to bend, stretch, stoop, stand, sit and lift up to 20 lbs
Ability to operate a keyboard, telephone, and other office equipment
Ability to examine documents for accuracy and completeness
Ability to prepare records in accordance to detailed instructions
Ability to communicate fluently in English and Spanish
Ability to maintain a positive work environment
Ability to work in a fast paced environment
Ability to maintain a flexible work schedule
Ability to maintain client and office confidentiality
Ability to fully comply with the enhanced infection control requirements of the clinic.
High school or GED.
Certified in Medical Office Specialist from an accrediting school or minimum of two years of experience in third party billing and collections and in processing payments on an automated system or, must be familiar with Private Insurance, Medicare and Medicaid claims filing.
Experience with CPT and ICD-9 coding.

Nice To Haves

Knowledge of provider credentialing and its direct impact on the practice revenue cycle.
Great customer service and telephone etiquette
Computer knowledge
Professional appearance
Attention to detail
Able to multitask and work in a fast-paced environment.
Ability to work well under stress and maintain calm under pressure
Work well with team members and willingness to cross-train.
Functions as a member of a collaborative health care team to create and maintain a patient centered medical home.
Employee must provide transportation.
If employee operates a personal motor vehicle in the performance of their official duties, the employee must possess a current valid Texas driver’s license for the appropriate type of vehicle and Texas Liability insurance.

Responsibilities

Manage the completion and submission of provider enrollment applications
Perform tracking and follow up to ensure providers, facilities are established timely and linked to appropriate entity.
Retain records related to completed enrollment applications.
Process applications for providers for re-credentialing with facilities and payers.
Responsible for tracking credentialing expiration of facilities and providers with accuracy and timeliness.
Works with other staff to streamline and improve processes related to credentialing and provider data
Obtains appropriate paperwork, reviews applications, and prepares verification letters
Ensure insurance directories are correct and up to date
Update providers/facility CAQH database file timely according to the schedule published by CMS
Complete revalidation requests issued by government or insurance payers
Complete credentialing applications to add providers to insurance payers.
Works closely with supervisor and billing staff to identify and resolve any denials or authorization issues related to credentialing.
Maintain accurate provider/facilities profiles on CAQH, PECOS and CMS or any other database.
Works on daily correspondence from insurances
Responsible for insurance, provider and EDI set-ups in Centricity
Responsible for new and/or amendments for insurance contracts
Travels to different clinics to obtain required information needed for credentialing.
Other duties assigned
Works closely with appropriate staff to resolve issues with the credentialing process to ensure proper deadlines are met.
Educates staff on credentialing process and standards as needed.
Maintains appropriate documentation and reporting regarding the credentialing process (application, DEA, liability insurance, etc) for each provider and facility.
Maintains a friendly environment for self and others.
Refrains from texting and speaking on the cell phone.
Refrains from informal communication with patients and others.
Fully participates in performance improvement and follows all Clinic policies and procedures.
Attends work on a regular and predictable schedule in accordance with clinic leave policy and performs other duties assigned.
Submits required documentation in a timely manner.