Credentialing Specialist- Medical Payer

Health Point Family Care; Florence (KY); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Retention bonus

Scrubs provided

Tuition reimbursement

Paid holidays

Birthday off

Paid time off

Health/dental/vision

401K & life insurance

Job summary

HealthPoint Family Care Florence in Florence, KY is seeking a Credentialing Specialist to manage applications, renewals, revalidations and terminations with accuracy and timeliness. You will coordinate provider credentials and facility processes, maintaining files and ensuring enrollment with Medicare, Medicaid and private payers.

The role requires knowledge of credentialing systems, strong attention to detail and solid communication skills.

Qualifications

• One year of experience in direct credentialing, including Medicare/Medicaid and payer applications.
• Knowledge of Ohio and Kentucky Medicaid and Medicare credentialing requirements.
• Professional and detail oriented with strong communication skills.
• Intermediate MS Outlook, Word and Excel skills.
• Training in medical billing or a related field is a plus.
• Ability to maintain credentialing files and enrollment applications.

Responsibilities

• Track and complete credentialing applications, renewals, revalidations and terminations.
• Coordinate credential processes for practitioners and facilities in the organization.
• Maintain provider credentialing files, NPDB inquiries, and CAQH/NPPES databases; ensure timely enrollment applications.
• Credential providers with Medicare, Kentucky and Ohio Medicaid and private payers for multiple services.
• Track application status with timely follow-up to ensure enrollment.
• Process payer applications, initial and re-applications and attestations.
• Understand Medicare, Medicaid and commercial payor processes and EDI agreements.
• Maintain credentialing files (paper and electronic).
• Coordinate and participate in all phases of credentialing/re-credentialing profiles.
• Track credentialing status with networks.
• Review, update, maintain and report fee schedules for payors within the group.
• Support Revenue Cycle projects as assigned.

Skills

Attention to detail

Verbal and written communication

Credentialing experience

Education

High School diploma

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Job Location: HealthPoint Family Care Florence - Florence, KY 41042

Position Type: Full Time

Education Level: High School

Job Shift: Day

Job Category: Admin - Clerical

HealthPoint Family Care is a private medical practice dedicated to patient wellness. The organization provides adult and pediatric medical, dental, mental health, substance abuse treatment, obstetrics and gynecology, and vision services. We offer walk-ins, same day appointments, evening and weekend hours for the convenience of our patients. We have locations in Northern and Central Kentucky.

Benefits

• Retention bonus of $1,500 paid at 18 month of employment- Additional retention bonus's up to $4,000
• Two free sets of HealthPoint scrubs
• Tuition Reimbursement for up to $1,000 a year.
• Nine paid federal holidays
• Birthday off paid in addition and not counted towards PTO
• Generous Paid Time Off
• Wide array of benefit plans such as health, dental, vision, flexible spending accounts, Safe Harbor 401K Plan, long term disability and group/voluntary life insurance plans.

Responsibilities

• Accurately tracks, records and collects necessary data from various sources to complete applications, renewals, revalidations and terminations.
• Responsible for coordinating the credential processes practitioners and facility in our growing healthcare practices.
• Maintains Provider credentialing files, initiates NPDB database inquiries, maintains NPPES and CAQH provider databases, and timely completion of Provider enrollment applications.
• Credential providers and facilities with Medicare, Kentucky and Ohio Medicaid and private payers for medical, mental health, women's health, dental and vision services.
• Tracks application status through timely follow-up to ensure enrollment.
• Responsible for processing of provider payor applications, initial, re-applications and attestations.
• Understands Medicare, Medicaid and commercial payor application process and EDI agreements.
• Maintain Credentialing files (paper and computer)
• Coordinates and participates in all phases of credentialing/re-credentialing profile process.
• Tracks and logs credentialing status routinely with participating networks.
• Review, update, maintain and report fee schedule for various payors within Group assigned.
• Aggressively collects, coordinates, reviews and documents performance data, which includes quality and utilization activities, member complaint data for re-credentialing purposes.
• Revenue Cycle projects as assigned.

Qualifications

• One year of experience in direct credentialing including primary source verification and completion of Medicare/Medicaid/commercial payer and hospital privileging applications. Applicants with less than one year experience will be considered with a training plan.
• Knowledge of Ohio and Kentucky Medicaid and Medicare credentialing requirements and systems.
• Proven methods for file maintenance and tracking required.
• Must be professional and detail oriented.
• Strong verbal and written communication skills.
• Intermediate level skills required in Microsoft Outlook, Word and Excel.
• Training in medical billing or a related field a plus