LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY, INC
Credentialing Specialist
LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY, INC, Miami, Florida, us, 33222
Overview
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Credentialing Specialist
role at
LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY, INC .
As a Credentialing Specialist for Little Havana Activities and Nutrition Centers you will be responsible to compile and maintain all relevant information and documentation for a provider’s file to be considered for participation within the network. This documentation includes, but is not limited to, applications, contracts, primary source verifications, insurance claims history, etc. In addition, you will be working closely with the provider, claims, provider relations, and case management department to ensure timely and appropriate follow up.
Responsibilities
This role is primarily an in-office position but will need to travel on the road to meet with clients.
Initiates, maintains and verifies all aspects of the credentialing and re-credentialing applications and process for providers.
Completes and reviews all applications to ensure accuracy and completeness prior to submission.
Manages a provider case load of approximately 200-300 providers.
Acts as a subject matter expert in determining provider terminations, encounter submissions, claims portal access/training, authorization process, reports handler, payment processing, inquiry submissions, etc.
Coordinates appointments with providers in a time efficient manner—coordinating travel time in addition to handling situations as they arise. Time sensitive reporting with same day turnaround time often required.
Handles a high volume of daily phone calls.
Adheres to program expectations through attention to detail and highly organized approach to ensure compliance with approval or denial timelines.
Facilitates provider trainings as necessary—trainings can include as many as 120 providers at one time; secures training locations and all necessary logistics.
Identifies “red flags” and addresses them accordingly in relation to provider’s ability to render services.
Job Specifications / Qualifications
Bachelor’s Degree in Health Related Field and one (1) year of Credentialing or Provider Data experience; OR High School Diploma / GED Equivalent with minimum of two (2) years of experience in Credentialing or Provider Data experience. Fully bilingual English/Spanish to provide services to a predominantly Hispanic, elderly client base.
Preferred Experience And Attributes
Experience and knowledge of Long Term Care (LTC) and/or Managed Care Organization (MCOs).
Excellent oral and writing skills
Strong customer service orientation with ability to educate providers, clients and staff.
Strong computer and data entry skills; Microsoft Word, Excel, Outlook & Internet searches
Effective and efficient organization and time management skills
Effective analytical and problem-solving skills
Ability to maintain strict confidentiality and handle sensitive information.
Good telephone and other distance communications skills; flexibility in dealing with simultaneous projects, issues, and timelines.
Ability to respond well under pressure and work in a fast-paced environment.
Equal Opportunity Statement It is the policy of LHANC to provide equal opportunity to all applicants and to administer ongoing employment matters in a manner which does not discriminate on the basis of an individual’s race, color, creed, religion, national origin, gender, age, marital status, disability, veteran status, genetic information, or any other basis protected by applicable state, federal, or local law.
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Credentialing Specialist
role at
LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY, INC .
As a Credentialing Specialist for Little Havana Activities and Nutrition Centers you will be responsible to compile and maintain all relevant information and documentation for a provider’s file to be considered for participation within the network. This documentation includes, but is not limited to, applications, contracts, primary source verifications, insurance claims history, etc. In addition, you will be working closely with the provider, claims, provider relations, and case management department to ensure timely and appropriate follow up.
Responsibilities
This role is primarily an in-office position but will need to travel on the road to meet with clients.
Initiates, maintains and verifies all aspects of the credentialing and re-credentialing applications and process for providers.
Completes and reviews all applications to ensure accuracy and completeness prior to submission.
Manages a provider case load of approximately 200-300 providers.
Acts as a subject matter expert in determining provider terminations, encounter submissions, claims portal access/training, authorization process, reports handler, payment processing, inquiry submissions, etc.
Coordinates appointments with providers in a time efficient manner—coordinating travel time in addition to handling situations as they arise. Time sensitive reporting with same day turnaround time often required.
Handles a high volume of daily phone calls.
Adheres to program expectations through attention to detail and highly organized approach to ensure compliance with approval or denial timelines.
Facilitates provider trainings as necessary—trainings can include as many as 120 providers at one time; secures training locations and all necessary logistics.
Identifies “red flags” and addresses them accordingly in relation to provider’s ability to render services.
Job Specifications / Qualifications
Bachelor’s Degree in Health Related Field and one (1) year of Credentialing or Provider Data experience; OR High School Diploma / GED Equivalent with minimum of two (2) years of experience in Credentialing or Provider Data experience. Fully bilingual English/Spanish to provide services to a predominantly Hispanic, elderly client base.
Preferred Experience And Attributes
Experience and knowledge of Long Term Care (LTC) and/or Managed Care Organization (MCOs).
Excellent oral and writing skills
Strong customer service orientation with ability to educate providers, clients and staff.
Strong computer and data entry skills; Microsoft Word, Excel, Outlook & Internet searches
Effective and efficient organization and time management skills
Effective analytical and problem-solving skills
Ability to maintain strict confidentiality and handle sensitive information.
Good telephone and other distance communications skills; flexibility in dealing with simultaneous projects, issues, and timelines.
Ability to respond well under pressure and work in a fast-paced environment.
Equal Opportunity Statement It is the policy of LHANC to provide equal opportunity to all applicants and to administer ongoing employment matters in a manner which does not discriminate on the basis of an individual’s race, color, creed, religion, national origin, gender, age, marital status, disability, veteran status, genetic information, or any other basis protected by applicable state, federal, or local law.
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