Lead Credentialing Specialist

Franciscan Alliance, Inc.

78d • $17 - $24

About The Position

You may not realize it but when you walk into a hospital, each and every person on the medical staff must have proper credentials. Someone has to handle the verification and credentialing process for each of those people. Someone with good attention to detail and strong communication skills. Perhaps someone like you! With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

Requirements

• High School Diploma/GED
• 1 year Revenue cycle or insurance claims processing, and auditing and payment resolution
• 2 years Payor enrollment experienced, Microsoft and electronic credentialing database systems
• 1 year Consistent back round of employment and/or Life Experience with skill set as detail oriented, able to communicate clearly and professionally; possess strong organization and time management skills, and have excellent interpersonal, verbal, and written communication skills
• 1 year experience with online payer sites

Nice To Haves

• Associate's Degree

Responsibilities

• Review and distribute incoming credentialing applications and application responses, as well as accompanying documents and actions or redirects, as necessary for follow-up.
• Prepare credentialing and re-credentialing applications on behalf of physicians/providers for submission to managed care companies and other agencies.
• Monitor the operations of a unit and provide input to the performance of individuals through feedback and recommendations.
• Oversee the completion and submission of electronic and paper claim applications.
• Communicate with internal and external customers, which includes bi-weekly calls with operational customers and payors.
• Ensure compliance with state and federal billing regulations and report any suspected compliance issues to leadership.
• Research Payor processes and online Payor participation in the Payor plans.
• Review daily worklist reports from the credentialing system, and delegate work based on the findings.
• Review outstanding high dollar credentialing account balances to ensure timely billing.
• Work with leadership and patient accounting staff, to improve processes, increase accuracy, and create efficiencies to achieve overall goals.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees