Credentialing Specialist HCS

Facility:      Administrative Regional Training Cntr

Shift: Shift 1

Status:     Full Time      FTE: 1.066667

Bargaining Unit:     Catholic Health Emmaus

Exempt from Overtime:     Exempt: No

Work Schedule:  Days

Hours:         

7:00 - 17:00

Summary:

The Credentialing Specialist is responsible for assisting with the process of electronic credentialing and enrolling them into insurances that are relevant to CHS. Communicate with provider’s staff and insurances. This requires electronic collection, processing and organizing significant amounts of enrollment data. Oversee the credentialing process in its entirety from start to finish.

Responsibilities:

EDUCATION

• A.A.S. Degree or equivalent certificate program required
• In lieu of an Associate’s degree, a minimum of three (3) years of direct credentialing experience required

EXPERIENCE

• Three (3) years of experience in a health care related field
• Web based credentialing and privileging software experience preferred
• Experience with Physician credentialing strongly preferred

KNOWLEDGE, SKILL AND ABILITY

• Strong Microsoft Office skills, knowledge of Word, Excel, Outlook, Adobe Acrobat knowledge
• Strong critical thinking skills
• Must have a high degree of integrity that is aligned with the values of the organization
• Ability to multitask
• Strong communication skills, both oral and written
• Ability to establish priorities and ability to work well under pressure
• Ability to provide work of high quality and accuracy
• Resourceful with strong research skills
• Strong interpersonal skills
• Good judgment, common sense and diplomacy
• Solid organizational skills
• Ability to work independently
• Ability to analyze data and prepare meaningful reports
• Ability to identify, react, and follow through in an appropriate manner in credentialing matters
• Must remain confidential on all Medical Staff matters
• Create individual and group NPIs as needed
• Create group contracts with insurance companies for physician practices
• Correspond with practitioners to sign applications and receive credentialing documents
• Update and attest CAQH on a regular basis
• Request annual COI from clients and upload into CAQH
• Complete Medicare and Medicaid re-validations when needed
• Track when Medicare and Medicaid re-validations are needed
• Submit completed payer applications to insurance payers
• Follow up with insurance payers to ensure credentialing is moving forward
• Create & maintain provider’s CAQH
• Remind practitioners of expiring DEA/Licensure
• Submit current DEA/Licensure to payers and CAQH as needed
• Team Player, assisting coworkers when needed
• Maintain updated documents and changes within the insurance Portals
• Obtain affiliation with Nursing Homes and hospitals for providers
• Apply for Malpractice for providers, approve invoices for payment
• Provide rosters to insurance companies as needed
• Maintain provider CME information, when requested
• Travel to obtain signatures from providers when applicable as well as travel to pick up or drop of pertinent paperwork
• Handle incoming and outgoing phone call from Insurances, providers, client managers, practice and billing staff
• Respond to numerous emails from clients, insurances, office and billing staff
• Research requests from office and billing staff regarding claim denials, provider out-of-network issues, etc.
• Updates to provider initial credentialing with location updates, name changes, etc.

WORKING CONDITIONS:

• Normal heat, light space, and safe working environment; typical of most office jobs
• Individual may be required to travel to other CH facilities for staff meetings/staff training