SCOPE / GENERAL PURPOSE OF JOB:
Responsible for the completion of timely credentialing and re-credentialing of health care providers with applicable payers and hospitals. Responsible for seeking resolution to problems with payers as they relate to credentialing, ensuring excellent communication with CBO management and clients, thereby assuring client satisfaction. Responsible for ensuring timely credentialing to allow revenue generation, obtaining accurate provider numbers and claim submission requirements to facilitate billing.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
· Demonstrates thorough understanding and knowledge of Government and Commercial payors’ credentialing processes/requirements.
· Prepares, reviews and submits credentialing applications.
· Prepares and submits payor verification letters and/or follow-up phone calls.
· Loads and maintains each credentialing client’s data within the Wybtrak database.
· Contacts medical office staff, licensing agencies, and insurance carriers to complete credentialing and recredentialing applications timely.
· Updates management regarding credentialing status per client.
· Maintains extensive working knowledge of the provider credentialing process.
· Expands knowledge base by participating in educational opportunities.
· Ensures strong communication with CBO management team.
· Ensures compliance with Company Policies and Procedures to maximize efficiency. Ensures compliance with appropriate industry regulations and State and Federal regulations.
· Maintains working knowledge of applicable laws and regulations as they relate to assigned responsibilities.
· Maintains confidentially of all information related to patients, clients, finances and cost effective health care delivery issues.
· Demonstrates the ability to work well with peers while ensuring a strong cohesive team.
· Additional duties as assigned.
EDUCATION AND/OR EXPERIENCE:
· 2-4 years of experience in physician credentialing. Healthcare business office processes and professional revenue cycle management experience a plus.
· Knowledge of organization policies and procedures.
· Knowledge of health care administration principals.
· Knowledge of basic business office billing policies and procedures.
· Knowledge of payor contracting, credentialing operating procedures and practices.
· Skill in exercising initiative, judgment, discretion, decision-making, negotiation processes and organizational skills to achieve business unit objectives.
· Skill in identifying and resolving problems.
· Ability to communicate effectively and professionally.
· Ability to establish and maintain effective professional working relationships with all employees and clients.
· Ability to communicate effectively orally and in writing.
· This position relies on experience and judgment to plan and accomplish goals.
CERTIFICATIONS / LICENSURES / CREDENTIALS: None
SUPERVISORY RESPONSIBILITIES: None
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires standing/sitting for extensive periods of time. Occasional lifting and carrying items weighing up to forty (40) pounds may be required. Requires corrected vision and hearing to normal range.
The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public.