Payer Credentialing Specialist - Full Time

Summary of Position: 

The Payer Credentialing Specialist is responsible for enrolling and credentialing providers with insurances in a timely manner while meeting payer criteria. This position requires adept communication and collaboration with payers, internal and external stakeholders as well as prioritizing provider contracting and credentialing needs to ensure fair reimbursement. 

Qualifications

Education:

• Bachelor’s degree preferred.

Experience:

• Minimum 2-3 years office experience, preferably in a healthcare, Insurance Payer or Physician Office experience

• Typing and computer literacy

• Reading and writing skills, organizing and filing, professional phone etiquette

• Sufficient computer skills as are required to complete an online application. 

• In compliance with patient safety standards, must be able to effectively communicate in English; Bilingual abilities preferred.

Knowledge/Skills/Abilities:

• Knowledge of regulations, credentialing standards, and policies required of all medical environments.

• Experience with the credentialing application, review, and approval process.

• Highly effective collaboration skills, written and verbal communications skills. 

• Ability to develop relationships with the various departments in order to establish a consistent and supportive process throughout the System. 

• Attention to detail, meticulous development and maintenance of regulatory paperwork.

• Extensive knowledge of Healthcare Revenue Cycle functions. 

• MD Staff experience preferred.

Certifications/Licensures:

• Provider Enrollment Specialist certification, PESC, preferred.

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• While performing the duties of this job, the employee is frequently required to walk, stand, sit, and talk or hear. 

• The employee is occasionally required to use hands to finger, handle, feel or operate objects, tools, or controls; and reach with hands and arms.

• The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl.

• Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.

• The employee must occasionally lift and/or move up to 25 pounds.

Working Conditions 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Normal office environment. The noise level in the work environment is usually quiet to moderate while in the office.

• Occasional travel to various health system locations. 

Essential Functions

1. Provides consistently exceptional care at all times.

2. Coordinates activities related to all Physician payer credentialing activities. 

3. Coordinates activities related to all Facility payer credentialing activities.

4. Performs tracking and follow-up to ensure providers numbers are established and linked to the appropriate entity in a timely manner. 

5. Maintains documentation and reporting regarding provider enrollments in process. 

6. Retains records related to completed payer credentialing applications. 

7. Establishes close working relationships with privileging staff, contracting staff, medical staff management and payer contacts. 

8. Understands specific application requirements for each payer including pre-requisites, required forms, form completion requirements, supporting documentation and CMS/Medicare guidelines. 

9. Maintains strict confidentiality with regard to protected health information, understands HIPAA Privacy Security policies and procedures.

10. Maintains strict confidentiality regarding provider information. 

11. Establishes department and staff goals and objectives in line with the mission, vision, values and strategic plan of Barton Healthcare System.

12. Responds to the needs of the department by performing other duties, as necessary.