What are the responsibilities and job description for the Credentialing Specialist position at GenPsych?
Job Summary:
A Credentialing Specialist is responsible for maintaining all credentialing for provider and facility locations.
Job Functions and Duties:
1. Enforce regulatory compliance and quality assurance
2. Ensure that all information meets legal, federal and state guidelines when processing applications.
3. Responsible for carrying out various credentialing processes in relation to physicians, facilities, and health practitioners.
4. Process timely and maintain credentialing and re-credentialing applications for commercial payers, Medicare, and Medicaid (when applicable).
5. Diligent follow up on all credentialing and re-credentialing applications and provide any missing information in a timely manner.
6. Prepare monthly reporting of all individual providers and facility credentialing status.
7. Maintains confidentiality of provider, facility, contract, and license information.
8. Compiles and maintains individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
9. Update and maintain accurate provider profiles on each provider's CAQH, database file.
10. Review and negotiate individual and facility rates with our current commercial contracts.
11. Work closely with the Billing Manager(s) and billing staff to identify and resolve any denials or authorization issues related to provider or facility credentialing.
12. Tracks license, contract, and certification expirations for all providers and facilities.
13. All other duties as assigned.
Qualifications:
1. Candidates must have a High School Diploma or GED with one to two years of experience.
2. Education or coursework in medical coding is desired.
3. Candidates must possess the following:
a. Knowledge of medical billing and collection practices.
b. Knowledge of basic medical coding and third party operating procedures/practices.
c. Ability to operate multi-line telephone system.
d. Professional attitude.
e. Ability to establish and maintain effective working relationships with patients and employees.
f. Ability to operate basic computer systems.
g. Organized and detail oriented.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
Work Location: In person
