Payer Credentialing Specialist
Description
POSITION SUMMARY:
Reporting to the Payer Credentialing Manager and the Director of Revenue Cycle & Finance, the Payer Credentialing Specialist is responsible for all aspects of the credentialing and, re-credentialing ,processes at Equitas Health. The Payer Credentialing Specialist is responsible for ensuring that all providers are credentialed and contracted with health plans, as well as maintaining up-to-date information for each provider and group location. The Payer Credentialing Specialist will collaborate with the Payer Credentialing Manager, the Revenue Department, Senior Leaders, Directors, and Managers in developing, implementing, and managing the workflow for payer credentialing and doing so in a timely and transparent manner. The Payer Credentialing Specialist will be expected to manage the organization’s Credential MyDoc software and credentialing spreadsheets under the direction of the Payer Credentialing Manager. This position requires the Payer Credentialing Specialist to be detailed oriented and have the communication skills to assist in creating an environment and culture that will enable Equitas Health to fulfill its mission and to meet, or exceed, its goals.
Reporting to the Payer Credentialing Manager and the Director of Revenue Cycle & Finance, the Payer Credentialing Specialist is responsible for all aspects of the credentialing and, re-credentialing ,processes at Equitas Health. The Payer Credentialing Specialist is responsible for ensuring that all providers are credentialed and contracted with health plans, as well as maintaining up-to-date information for each provider and group location. The Payer Credentialing Specialist will collaborate with the Payer Credentialing Manager, the Revenue Department, Senior Leaders, Directors, and Managers in developing, implementing, and managing the workflow for payer credentialing and doing so in a timely and transparent manner. The Payer Credentialing Specialist will be expected to manage the organization’s Credential MyDoc software and credentialing spreadsheets under the direction of the Payer Credentialing Manager. This position requires the Payer Credentialing Specialist to be detailed oriented and have the communication skills to assist in creating an environment and culture that will enable Equitas Health to fulfill its mission and to meet, or exceed, its goals.
SALARY:$48,900-$61,100
ESSENTIAL JOB FUNCTIONS:
Essential functions of the job include, but are not limited to, organization; exercising professional judgment; traveling when needed,; strong written communication skills; relationship building; utilizing a computer for typing and research; attending meetings; and presenting to small group
MAJOR AREAS OF RESPONSIBILITIES:
MAJOR AREAS OF RESPONSIBILITIES:
- Credentialing & Contracted Providers. Maintain documentation of credentialing. Act as Equitas Health’s Credentialing Specialist for our current provider and payor credentialing, under the direction of the Payer Credentialing Manager, to ensure documentation for providers and payers are accurate and timely. Generating reports as needed or directed for monthly meetings as necessary. Work with Credentialing, the Revenue Cycle Manager, and Equitas Operations, as directed by the Payer Credentialing Manager or as needed, to ensure appropriate communications. Ensure relevant organizational attestations are completed timely, and act as an internal and external resource regarding credentialing and privileging by providing thorough, thoughtful answers to questions in a timely manner. Maintain consistent contact with providers to ensure that expectations are clear, and requirements are completed in a timely manner. Review credentialing files and work with providers to obtain missing, incomplete and expiring items, whenever necessary under direction of the Credentialing Payer Manager.
- Payor Credentialing. Assist with processing the payor credentialing documentation under the direction of the Payer Credentialing Manager. Maintain knowledge of current health plan requirements for credentialing providers including managing delegated health plans. Report to the Payer Credentialing Manager any organizational changes required to maintain compliance with health plans. Transition payor credentialing to outsourced OCS delegated services as an EH BA partner, and Liaison with OCS for remaining in house responsibilities and tasks to ensure smooth operations and compliance of credentialing.
- Provider Requirements for Payer Credentialing. Assist with maintaining provider’s CAQH and obtaining copies of current state licenses, DEA certificates, malpractice coverage certificates and any other required insurance documents for all relevant employees/contractors. Work closely with Payer Credentialing Manager to ensure all employees/contractors have required documents for payer credentialing.
Policies & Procedures. Assist the Payer Credentialing Manager if there are Amendments needed to current Credentialing & Privileging Policies and Procedures as needed. Create and update as needed department workbook on the credentialing processes and obtain approvals for implementations from Payer Credentialing Manager.
- Quality of Work. Work with Payer Credentialing Manager regarding Credentialing. Ensure that all appropriate documentation is completed and tracked in an auditable format. Work with Payer Credentialing Manager to ensure all documentation is saved and stored appropriately.
- External Audits & Accreditation. Collaborate with external auditors whenever necessary to Assist, when directed, with document production for organization. Ensure compliance with HRSA-FQHC, CARF, URAC, and any other standards or payer contracting rules regarding credentialing and privileging.
- Continuous Education. Join and participate in relevant trade associations regarding credentialing and privileging to ensure that process us up to date with any regulatory changes.
- Technology. Review and choose software system to streamline the credentialing process.
Knowledge, Skills, Abilities and other Qualifications:
- Associate’s degree is preferred, but 3-5 years’ experience may be substituted
- Experience in community health center credentialing preferred.
- Experience with operationalizing a credentialing program is preferred.
- Past audit experience preferred.
- Familiar with Medicaid and Medicare enrollment procedures and protocols for physician and mid-level credentialing preferred.
- Ability to develop a rapport with staff to provide them with a realistic and efficient credentialing process.
- Strong written and verbal communication skills a must.
It is the policy of Equitas Health that no employee or applicant will be discriminated against because of race, color, religion, creed, national origin, gender, gender-identity and expression, sexual orientation, age, disability, HIV status, genetic information, political affiliation, marital status, union activity, military, veteran, and economic status, or any other characteristic protected in accordance with applicable federal, state, and local laws. This policy applies to all phases of its personnel activity including recruitment, hiring, placement, upgrading, training, promotion, transfer, separation, recall, compensation, benefits, education, recreation, and all other conditions or privileges of employment.
Equitas Health values diversity and welcomes applicants from a broad array of backgrounds.