Insurance Credentialing Specialist - Oak Orchard Health : Job Details

Insurance Credentialing Specialist

Brockport, NY ( - Finance

Description

Do you want to be part of a leading, patient-centered organization where professionals come together to improve access to quality health care for all? At Oak Orchard Health, you can grow your career with the fulfilment and satisfaction of knowing that your work is making a difference in someone's life. We have 8 medical offices located in communities throughout Western NY and we continue to expand and recruit top talent with our mission to ensure everyone has access to affordable, quality health care. Our diverse, highly skilled professionals are the reason for our success, from physicians to nurses to administrators and support personnel. If you're passionate about serving all with excellence, equity, inclusion, respect, and dignity, we think you'll fit right in! Diverse and bilingual candidates are encouraged to apply.

We offer:

+ Tuition Reimbursement and Student Loan Forgiveness (PSLF) Eligible!

+ Flexible schedule that promotes a healthy work life balance!

+ Competitive wages!

+ Comprehensive benefit package (health/vision/dental) that starts the first of the month after your hire date!

+ Retirement Plan 403(b) with a competitive company match

+ Organizational support of continuing education and professional development!

+ Company paid life Insurance!

+ Generous PTO package that includes Vacation time, Sick time, Personal Days, Floating Holidays, and Company paid holidays!

The Insurance Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, commercial payers, Medicare and Medicaid. Maintain up-to-date data for provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

JOB RESPONSIBILITIES

+ Compiles and maintains individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.

+ Maintain internal provider grid to ensure all information is accurate and logins are available.

+ Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

+ Maintains confidentiality of provider information.

+ Update each provider's CAQH database file timely according to the schedule published by CMS.

+ Apply for and renew annually all providers' licenses: Professional, DEA, and Controlled Substance.

+ Complete revalidation requests issued by government payers.

+ Complete credentialing applications to add providers to commercial payers, Medicare and Medicaid

+ Complete re-credentialing applications for commercial payers.

+ Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.

+ Ensures practice addresses are current with health plans, agencies and other entities.

+ Audits health plan directories for current and accurate provider information.

+ Reviews payer newsletters and compiles relevant information to share with internal stakeholders.

+ Works closely with the Director of Revenue Cycle and Billing Staff to identify and resolve any denials or authorization issues related to provider credentialing.

+ Attends meetings with Insurance Representatives as needed.

+ Assist with the development of continuous improvement strategies for the Revenue Cycle.

+ Adheres to, both, departmental and OOH policy and procedures.

+ Other duties as assigned by the Director of Revenue Cycle.

Requirements

Skills/Qualifications:

+ Working knowledge of provider credentialing and its direct impact on the Revenue Cycle.

+ Ability to organize, prioritize duties and goals of the department.

+ Excellent verbal and written communication skills including letters, memos and emails.

+ Excellent attention to detail.

+ Ability to research and analyze data.

+ Ability to work independently with minimal supervision.

+ Ability to establish and maintain effective working relationships with internal and external stakeholders.

+ Must demonstrates professional demeanor.

+ Proficiency in using PCs, Faxing, Scanning, Internet, Microsoft Office suite, and ADOBE PDF, required.

+ Ability to multitask and to confront new issues on a regular basis.

Education/Experience:

+ High School Diploma or equivalent, required.

+ Associates Degree or higher, preferred.

+ Certified Provider Credentialing Specialist (CPCS), preferred.

+ Three or more years of relevant credentialing experience, required.

Comprehensive Benefits:

+ Health / Dental /Vision Insurance

+ Retirement Plan

+ Tuition Reimbursement

+ Public Service Loan Forgiveness

+ Generous Time Off

Salary Description

23.00-26.00