Job description
Summary:
Responsible for ensuring providers are credentialed, appointed and privileged with health plans, hospitals and patient care facilities as needed. Maintain up to date data for each provider in various credentialing databases/systems and ensures timely renewal of all licensure and certification requirements for insurance purposes. Works closely with Provider Onboarding & Scheduling Specialist.
Responsible for ensuring providers are credentialed, appointed and privileged with health plans, hospitals and patient care facilities as needed. Maintain up to date data for each provider in various credentialing databases/systems and ensures timely renewal of all licensure and certification requirements for insurance purposes. Works closely with Provider Onboarding & Scheduling Specialist.
Other information:
Minimum 2 years experience in a healthcare office setting. Proficiency in the use of online credentialing databases and systems, i.e. NPI, PECOS, CAQH; Microsoft Office Applications (Word, Excel) and internet resources. Prior experience with medical billing and claims payment system requirements as it relates to provider enrollment. Ability to obtain Certified Provider Credentialing Specialist (CPCS) within two years.Experience with medical provider credentialing process, policies and procedures, including delegated credentialing requirements; familiarity with medical billing and claims payment system requirements as it relates to provider enrollment; demonstrated ability to work independently, with strong written and oral communication skills to effectively correspond with all levels of personnel and physicians/providers. Excellent attention to detail, with high degree of accuracy; ability to manage multiple projects efficiently and accurately. Requires exceptional critical thinking skills, sound judgment. Proficient use of Microsoft Office Applications (Word, Excel), credentialing software programs (NPI, PECOS, CAQH) and internet resources.
Responsibilities:
Must be current with knowledge of online credentialing databases and systems Must have be extremely organized and detail-oriented in maintaining accurate provider records of all required licensure, professional liability, practice locations and any and all other verifications requested. Maintains current knowledge of accrediting body standards. Maintains confidentiality of provider and Group's information and documentation Familiarity with medical billing and claims payment system requirements as it relates to provider enrollment and the provider credentialing process. Maintains open communication with CBO Manager and Group's contractual payors. Maintains current knowledge of insurance payer base provider requirements and assures compliance with all regulatory requirements. Maintains open communication with medical credentialing staff at Beebe Healthcare
Competencies and skills:
Essential:
- Knowledge Of Office Equipment
- Clear Communication Skills Both Written And Verbal
- Knowledge Of Basic Computer Programs
- Able To Keep Confidential Information Regarding Patients, Team Members
- Able To Withstand Crisis Situations
- Has Skills To Provides Customer Service To Patients, Team Members And Visitors
- Experience With Excel, Power Point, Word, Visio, Etc.
Education:
Essential:
- High school graduate or equivalent
Location: BMG Management
Shift : 8am-4:30pm Monday - Friday
FTE: 1.000000
Work Status: Full Time
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