Catholic Health System
Salary: 24.52-36.78 USD
Facility: Administrative Regional Training Cntr
Shift: Shift 1
Status: Full Time FTE: 1.066667
Bargaining Unit: Catholic Health Emmaus
Exempt from Overtime: Exempt: No
Work Schedule: Days
Hours:
Standard work schedule: 8:00 am - 4:30 pm M - F
Summary:
The Credentialing Specialist is responsible for assisting with the process of electronic credentialing and enrolling them into insurances that are relevant to CHS. Communicate with provider's staff and insurances. This requires electronic collection, processing and organizing significant amounts of enrollment data. Oversee the credentialing process in its entirety from start to finish.
Responsibilities:
EDUCATION
A.A.S. Degree or equivalent certificate program required
In lieu of an Associate's degree, a minimum of three (3) years of direct credentialing experience required
EXPERIENCE
Three (3) years of experience in a health care related field
Web based credentialing and privileging software experience preferred
Experience with Physician credentialing strongly preferred
KNOWLEDGE, SKILL AND ABILITY
Strong Microsoft Office skills, knowledge of Word, Excel, Outlook, Adobe Acrobat knowledge
Strong critical thinking skills
Must have a high degree of integrity that is aligned with the values of the organization
Ability to multitask
Strong communication skills, both oral and written
Ability to establish priorities and ability to work well under pressure
Ability to provide work of high quality and accuracy
Resourceful with strong research skills
Strong interpersonal skills
Good judgment, common sense and diplomacy
Solid organizational skills
Ability to work independently
Ability to analyze data and prepare meaningful reports
Ability to identify, react, and follow through in an appropriate manner in credentialing matters
Must remain confidential on all Medical Staff matters
Create individual and group NPIs as needed
Create group contracts with insurance companies for physician practices
Correspond with practitioners to sign applications and receive credentialing documents
Update and attest CAQH on a regular basis
Request annual COI from clients and upload into CAQH
Complete Medicare and Medicaid re-validations when needed
Track when Medicare and Medicaid re-validations are needed
Submit completed payer applications to insurance payers
Follow up with insurance payers to ensure credentialing is moving forward
Create & maintain provider's CAQH
Remind practitioners of expiring DEA/Licensure
Submit current DEA/Licensure to payers and CAQH as needed
Team Player, assisting coworkers when needed
Maintain updated documents and changes within the insurance Portals
Obtain affiliation with Nursing Homes and hospitals for providers
Apply for Malpractice for providers, approve invoices for payment
Provide rosters to insurance companies as needed
Maintain provider CME information, when requested
Travel to obtain signatures from providers when applicable as well as travel to pick up or drop of pertinent paperwork
Handle incoming and outgoing phone call from Insurances, providers, client managers, practice and billing staff
Respond to numerous emails from clients, insurances, office and billing staff
Research requests from office and billing staff regarding claim denials, provider out-of-network issues, etc.
Updates to provider initial credentialing with location updates, name changes, etc.
WORKING CONDITIONS:
Normal heat, light space, and safe working environment; typical of most office jobs
Individual may be required to travel to other CH facilities for staff meetings/staff training
REQNUMBER: 39904
Facility: Administrative Regional Training Cntr
Shift: Shift 1
Status: Full Time FTE: 1.066667
Bargaining Unit: Catholic Health Emmaus
Exempt from Overtime: Exempt: No
Work Schedule: Days
Hours:
Standard work schedule: 8:00 am - 4:30 pm M - F
Summary:
The Credentialing Specialist is responsible for assisting with the process of electronic credentialing and enrolling them into insurances that are relevant to CHS. Communicate with provider's staff and insurances. This requires electronic collection, processing and organizing significant amounts of enrollment data. Oversee the credentialing process in its entirety from start to finish.
Responsibilities:
EDUCATION
A.A.S. Degree or equivalent certificate program required
In lieu of an Associate's degree, a minimum of three (3) years of direct credentialing experience required
EXPERIENCE
Three (3) years of experience in a health care related field
Web based credentialing and privileging software experience preferred
Experience with Physician credentialing strongly preferred
KNOWLEDGE, SKILL AND ABILITY
Strong Microsoft Office skills, knowledge of Word, Excel, Outlook, Adobe Acrobat knowledge
Strong critical thinking skills
Must have a high degree of integrity that is aligned with the values of the organization
Ability to multitask
Strong communication skills, both oral and written
Ability to establish priorities and ability to work well under pressure
Ability to provide work of high quality and accuracy
Resourceful with strong research skills
Strong interpersonal skills
Good judgment, common sense and diplomacy
Solid organizational skills
Ability to work independently
Ability to analyze data and prepare meaningful reports
Ability to identify, react, and follow through in an appropriate manner in credentialing matters
Must remain confidential on all Medical Staff matters
Create individual and group NPIs as needed
Create group contracts with insurance companies for physician practices
Correspond with practitioners to sign applications and receive credentialing documents
Update and attest CAQH on a regular basis
Request annual COI from clients and upload into CAQH
Complete Medicare and Medicaid re-validations when needed
Track when Medicare and Medicaid re-validations are needed
Submit completed payer applications to insurance payers
Follow up with insurance payers to ensure credentialing is moving forward
Create & maintain provider's CAQH
Remind practitioners of expiring DEA/Licensure
Submit current DEA/Licensure to payers and CAQH as needed
Team Player, assisting coworkers when needed
Maintain updated documents and changes within the insurance Portals
Obtain affiliation with Nursing Homes and hospitals for providers
Apply for Malpractice for providers, approve invoices for payment
Provide rosters to insurance companies as needed
Maintain provider CME information, when requested
Travel to obtain signatures from providers when applicable as well as travel to pick up or drop of pertinent paperwork
Handle incoming and outgoing phone call from Insurances, providers, client managers, practice and billing staff
Respond to numerous emails from clients, insurances, office and billing staff
Research requests from office and billing staff regarding claim denials, provider out-of-network issues, etc.
Updates to provider initial credentialing with location updates, name changes, etc.
WORKING CONDITIONS:
Normal heat, light space, and safe working environment; typical of most office jobs
Individual may be required to travel to other CH facilities for staff meetings/staff training
REQNUMBER: 39904