Credentialing Assistant and Virtual Front Desk

Staff4Me; United States; Remote; USD 40,000 - 70,000; Full time

Job summary

Join a forward-thinking company as a Credentialing Assistant, where your attention to detail and organizational skills will shine. This role involves conducting insurance follow-ups, managing patient cases, and ensuring compliance with healthcare regulations. You'll collaborate closely with insurance providers and support patient care from initial contact to discharge. This dynamic position offers the opportunity to work in a fast-paced environment, contributing to a seamless patient experience while enhancing your skills in healthcare administration. If you're passionate about making a difference in patient care, this is the perfect role for you.

Qualifications

• Expertise in insurance follow-up and credentialing processes.
• Strong organizational skills with attention to detail.

Responsibilities

• Conduct weekly follow-ups for commercial insurances.
• Ensure patient care exceeds expectations from check-in to discharge.

Skills

Attention to detail

Organization and time management

Data entry and administrative skills

Knowledge of credentialing processes

Communication skills

Problem-solving abilities

Confidentiality and compliance awareness

Experience in healthcare administration

Familiarity with medical licensing bodies

Education

High School Diploma

Associate's Degree in Healthcare Administration

Tools

Credentialing software (CAQH, Modio, Verity)

Microsoft Office Suite

Job description

The credentialing assistant will be a skilled professional with expertise in insurance follow-up. This role entails conducting weekly follow-ups for all commercial insurances selected by the client, ensuring comprehensive documentation is provided, and collaborating closely with insurance providers to facilitate the completion of enrollment (achieving in-network enrollment status) with each follow-up, as well as current contract inquiries. Each VFD team member will be assigned various duties using the VFD Responsibility Matrix. While all team members will be cross-trained to perform all duties across clinics, everyone will have ownership over specific tasks and provide backup support to others.

Responsibilities:

1. Provide a seamless experience for patients: Ensure patient care exceeds expectations from initial contact to discharge. All patients should arrive on time as scheduled throughout their entire Plan of Care. Collect all OTC $ due at the time of service to support business operations.
2. Patient check-in: Greet patients and check for missing information.
3. Collect OTC: Collect OTC due at the time of service, provide receipt, and record in EMR.
4. Scheduling:
   1. New patients
   2. Re-visits
   3. Utilize cluster booking strategy to maximize efficiency
   4. Use cancellation or waitlist to fill open slots
   5. Dropped patients
   6. Patient reactivations
   7. Handle late arrivals and missed appointments
   8. Schedule full Plans of Care with therapists using PT order slip
5. Maintain POCs: Use the % prescribed tab on stat grid to monitor unsigned POCs.
6. Maintain referrals and requests as needed.
7. Patient communication:
   1. Check front desk email regularly
   2. Monitor website submissions
   3. Monitor fax
   4. Manage all incoming calls
   5. Complete confirmation calls unless automated system is in place
8. Provider communication:
   1. Resolve schedule conflicts with therapists via IM
   2. Notify therapists of physician communications via IM
   3. Fax documentation to physicians within 24 hours
9. Manage patient cases in EMR:
   1. Create patient case in EMR with intake data
   2. Ensure current information is on file (ID, insurance, demographics, privacy forms, etc.)
   3. Digitally file all new patient info
10. Reporting:
    1. Run daily reports using EMR
    2. Complete Front Desk Stat Grid daily
    3. Maintain % prescribed tracking for patient frequency compliance
11. Review and correct unbilled lists, update insurance information, and maintain detailed status notes.

Hard and Soft Skills:

• Attention to detail
• Organization and time management
• Data entry and administrative skills
• Knowledge of credentialing processes and healthcare regulations
• Proficiency in credentialing software (e.g., CAQH, Modio, Verity)
• Communication skills
• Problem-solving abilities
• Confidentiality and compliance awareness
• Experience in healthcare administration or credentialing (a plus)
• Familiarity with medical licensing and accreditation bodies
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook)