A highly motivated professional with knowledge and/or experience in multi-specialty physician office. Responsible for credentialing process for all physicians and extenders of the Clinic. Oversee on-going activities related to the development, implementation, maintenance of, and adherence to Boice-Willis Clinic's policies and procedures covering the privacy of, and access to, patient health information in compliance with federal and state laws and the Clinic's information privacy practices. The ideal candidate will require strong data entry skills and attention to detail with proficiency in Microsoft Office Suite (Excel, Word, Access, and PowerPoint).
Duties/Responsibilities:
- Coordinate credentialing and recredentialing process for physicians and extenders with insurance companies and all practicing facilities
- Ensure all required licensure and certifications are updated and records maintained accurately for practice locations and physicians
- Ensure CAQH information is updated in a timely manner
- Work with malpractice carrier to ensure coverage is updated and maintained
- Update and distribute weekly credentialing reports
- Manage all aspects of the payer enrollment and re-enrollment process
- Maintain a current knowledge of all components of the process as well as information management
- Process the workflow regarding insurance enrollment and credentialing processes for all practitioners
- Maintain current knowledge of all verification procedures, data entry procedures and report development and production
- Serve as resource to other staff members in reference to credentialing for all insurance enrollment and credentialing procedures
- Participate in performance improvement activities on all aspects of the insurance enrollment and credentialing process
- Adhere to the confidentiality policy
- Communicate appropriately with Physician's regarding credentialing and insurance enrollment for new providers and new practices with government and commercial insurance carriers
- Maintain a current list of providers NPI and other insurance related ID numbers
- Contact employed/contracted physicians as necessary to maintain current and accurate information within NPPES, CAQH, and Physician credentialing files.
- Maintain a working knowledge of applicable Federal, State, and Local laws and regulations, including the Standards of Conduct, Code of Ethics, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behaviors
- Supports and conducts oneself in a manner consistent with customer service expectations.
- Other duties assigned by management
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Required Skills/Abilities: - Strong analytical, problem solving and planning skills.
- Ability to work effectively independently and multi-departments.
- Ability to display sense of urgency while remaining organized with attention to detail.
- Excellent customer service, oral and written communication skills, organization, and attention to detail with limited supervision necessary.
Education & Experience: - High school diploma or equivalent. Associate’s or Bachelor’s Degree in Business, Medical Office Administration, or related field is preferred.
- Payer Credentialing experience is required.
- 2 years of healthcare experience is required.
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