Job Details

Description

Pay:

Job Overview: This position entails communicating directly with the providers in person, via email and/ or via phone, as well as hospitals and/ or insurance companies. You will be responsible for enrolling and maintaining the participation status of the providers with hospitals and/ or insurance companies, as well as verifying demographic information and providing up to date licensures to ensure the most accurate information on file for the providers.

Responsibilities and Duties:

• Communicate with provider to obtain all documents necessary to credential.

• Contact insurances and/or hospitals to initiate the application process.

• Complete and submit hospital and/or insurance applications with all necessary signatures and applicable documents.

• Communicate with the insurances and/or hospitals to follow up on the status of applications.

• Complete and submit Electronic Remittance Advice and Electronic Funds Transfer forms.

• Transfer letters in notes, scan, and file

• Input detailed notes of daily activity in spreadsheet.

• Verify, complete & submit provider demographic forms to insurances.

• Send out updated licensures upon renewal to insurances and/or hospitals.

• Maintain email volume, work in a timely manner.

• Answer phone, attend call and/or route as needed.

• Review and approve insurance contracts.

• Manage fee Schedule Negotiations.

• Manage CAQH updates and attestation.

• Track and ensure all credentialing for all employees on site and remote.

• Manage Credentialing Software.

• Assist employees with questions or concerns.

• Enforce office rules and regulations.

• Provider disciplinary action when required.

• Set new credentialing guidelines.

• Assist employees with daily work duties.

• Resolve any issue at hand by using resources available.

Qualifications:

• High School Diploma

• Five years credentialing experience

Skills:

• Microsoft word, Excel, Outlook

• Basic computer skills

• Multi-task

• Detail-oriented

• Able to work fast pace

• Self-motivated

• Positive attitude

• Professional personality

• Organization

• Follow-up skills

• Able to handle high volume workload

• Customer Service

• Good Communication

The employee’s job description can change without notice. The tasks that are listed on the job

description are not limited to just what is listed. The employee may be asked to do tasks that are not

listed on their job description at any time.