Credentialing & Contracting Specialist - Remote Job at Access Health Care Physicians, LLC
The Credentialing & Contracting specialist is responsible for conducting both Credentialing and contracting tasks for Individual providers or providers group, classifying and recording provider information to ensure the Credentialing records are accurate and send clean packages to insurance plans. The Specialist is responsible for analyzing the most used codes by the practice, getting the correct fee schedule and preparing all documentation to negotiate provider contract with health plans.
Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as required for Mirra and/or Mirra clients, customers, and affiliates.
- Review primary source verification information for each applicant and prepare a Credentialing Checklist.
- Work in conjunction with the Medical Director to prepare applicants for presentation to the Credentialing Committee including preparation of the Agenda.
- Take and prepare “minutes” of the Credentialing Committee, complete any assigned follow-up activities, prepare a summary of the results of the meeting for distribution to key departments, and file final credentialing documents.
- Analyze the most used codes within specific fee schedules by specialty practice to negotiate provider contract with health plans
- Responsible for negotiation and renegotiation of agreements
- Supports client onboarding and set up of provider profile.
- Helps training staff on Credentialing and Contracting processes while carries out recurring work using established procedures, conferring with the supervisor or higher-level specialists as necessary on technical problems.
- Reviews provider document and registration forms to prepare Data entry packages for outsourcing team, audit the work by outsource team and provide feedback to send clean enrollment packages to Health Insurance plans.
- Creates and enters practitioner data into profile, CAQH, provider portal, applications and group applications in credentialing software and obtains missing information and/or documents required, as needed.
- Responsible for contract grid updates, client notification and announcements.
- Prepares summaries for missing information request, notes for tasks and peer review. Prepares final committee-ready credentialing provider files for delegated clients.
- Adheres to strict confidentiality guidelines and Code of Conduct standards; conforms to defined processes in compliance with quality standards, NCQA, URAC, and CMS regulatory requirement.
- Assists health providers with routine questions pertaining to credentialing and contracting
- Sends expired license, insurance, COI, DEA, etc. notifications to providers and update provider records.
- Responsible for re-credentialing applications and follow through with health insurance plans.
- Organizes provider files and re-credentialing files.
Desired Competencies
- PECOS experience
- CAQH experience
- ADOBE and Microsoft proficiency with strong practical Excel experience
- Strong Contracting and Negotiation of provider agreements
- General delegation credentialing knowledge
- NCQA, URAC and CMS Regulation knowledge
- Customer Service experience
- Billing/ Claims experience
- Ethical Conduct
- Thoroughness, attention to detail
Supervisory Responsibility
This position has no supervisory responsibilities.
Work Environment
This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
This is a largely sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.
Position Type and Expected Hours of Work
This is a full-time position. Typical days and hours of work are Monday through Friday, 8:00 a.m. to 5 p.m.
Travel
No travel is expected for this position.
Required Education and Experience
- High school diploma or equivalent plus three to four years’ previous experience highly desired.
- Must type at least 48 words per minute
- Previous experience in Managed Care and Medicare preferred
- Experience in Billing/ Claims with fee schedule knowledge a preferred
- Excellent Customer Service Skills
Preferred Education and Experience
- CPCS certification preferred.
Work Authorization/Security Clearance
EEO Statement
I-9
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Please Note :
toshibalba.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, toshibalba.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.