Credentialing Specialist

Southwestern Healthcare, Inc. and its affiliate corporations are the largest providers of community-based behavioral healthcare in Southwestern Indiana, offering a full range of mental health and addictions treatment and related educational services.

We are seeking a full-time Credentialing Specialist who will be responsible for all aspects of the credentialing and re-credentialing processes and maintaining active status for all licensed clinicians who provide patient care. 

WHY WORK FOR SOUTHWESTERN?

• AFFORDABLE Health, Dental, Vision, and Voluntary Life Insurance that starts DAY ONE of employment!
• 401K Employer Contribution & Match
• Student Loan Assistance Program
• Physical & Financial Wellness Programs
• Generous Paid Time Off plan
• Competitive Total Compensation Program
• We are GROWING!! 

WHAT IS THIS POSITION RESPONSIBLE FOR?

• Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
• Ensure all information is accurate and logins are available.
• Update each provider’s CAQH database file timely according to the schedule published by CMS.
• Complete credentialing and re-credentialing applications, as necessary, to add providers to commercial payers, Medicare, and Medicaid.
• Work closely with the Patient Financial Services Supervisor and/or Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Sets up and maintains provider information in online credentialing databases and system.
• Ensure compliance with applicable laws, regulations, policies and procedures.
• Performs extensive account follow up activities utilizing the PMS.  Investigates, analyzes and resolves problematic and delinquent accounts.  Utilizes ancillary applications and websites as a tool to retrieve medical documentation, claim status, eligibility, billing guidelines, or authorization/referrals to substantiate correct claim submissions, written appeals, or coding reviews.
• Verifies insurance coverage and submits claims to insurance companies.
• Responsible for answering phones and assisting patients and interdepartmental staff with billing inquiries.
• Processes daily and monthly reports, including aging.
• Select appropriate accounts to be reviewed by the manager to determine for bad debt or sent to a collection agency.
• Review and process patient and/or insurance company refunds.
• Perform related duties and responsibilities as required.

Qualifications

WHAT'S REQUIRED FOR THIS POSITION?

• High School diploma or GED.
• Two years credentialing experience preferred.  Previous medical office experience required.
• Certified Provider Credentialing Specialist (CPCS) preferred.
• Knowledge of provider credentialing and its direct impact on the company’s revenue cycle.
• Excellent computer skills including Excel, Word, and Internet use.
• Detail oriented with above average organizational skills.
• Plans and prioritizes to meet deadlines.
• Excellent customer service skills; communicates clearly and effectively.
• Candidates must pass required background checks including county/state checks, CPS check, sex offender registry check, and drug screen.

If you are interested in joining a fun, friendly, innovative team, apply today!

EOE/AA including Veterans and Disabled

If you are a person with a disability needing assistance with the application process, please call (812) 435-2057.