Responsible for all aspects of provider enrollment, credentialing, recredentialing and privileging as requested for all billing/credentialing client providers (medical, dental, mental health) with respective health plans and/or facilities. Responsible for maintaining up to date data for each provider in credentialing databases and online systems; ensuring timely renewal of licenses and certifications.
- High School education required.
- 2 years of applicable higher education preferred.
- 2 years of relevant credentialing experience preferred.
- Certified Provider Credentialing Specialist (CPCS) preferred.
- Knowledge of current health plan and agency requirements for credentialing providers.
- Knowledge of computer operations including Microsoft Office applications, credentialing software and internet applications.
- Knowledge of billing procedures in a medical office setting.
- Ability to key 60 wpm.
- Demonstrates a high level of motivation and initiative to accomplish goals with minimal supervision.
- Superior communication skills both oral and written.
- Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
- Knowledge of Federal, State, and Local legal, compliance & regulatory provision related to billing practices in a medical office.
- Ability to organize and prioritize work and manage multiple priorities.
- Excellent attention to detail.
- Ability to research and analyze data.
- Ability to work well independently or with a group.
- Commitment: Participates and is part of the team.
- Control: Moves forward within the discipline of the team.
- Contagious: Brings a positive and enthusiastic attitude to the team.
- Communication: Listens and openly discusses issues facing the team.
- Comfortable: Builds trust and open working relationships within the team.
- Creative: Works with the team to bring synergy to the resolution of issues for the team.
Customer Service Skills
- Presents a positive attitude to the public; treats each customer with respect, dignity, and kindness.
- Maintains a businesslike and professional demeanor in all dealings with the public.
- Listens and learns what the customer wants before helping customers resolve issues.
- Goes the extra mile to help customers resolve their issues.
- Supports the Mission, Vision and Values of Moore Support Services, INC
- Follows all policies/procedures of the Company’s Corporate Compliance Plan, HIPAA.
- Reports any incidents/violations of Privacy/Security and OSHA/Safety policies to management.
- Maintains the strictest confidentiality in all functions as it relates to company financial/proprietary information and patient protected health information.
- Demonstrates a commitment to service excellence and quality improvement.
Job Duties and Responsibilities
- Compiles and maintains current and accurate data for all providers including but not limited to licenses, DEA, continuing education, malpractice coverage, Curriculum Vitae, and Universal Practitioner Application.
- Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed. Completes provider privileging applications as requested.
- Sets up and maintains group contracts with health plans.
- Sets up and maintains provider information in online credentialing databases (ie. CAQH) and Modio credentialing database.
- Tracks license and certification expirations for all providers to ensure timely renewals.
- Reports credentialing status to providers/offices/clinics.
- Ensures practice addresses are current with health plans, agencies and other entities.
- Audits Payer/Health Plan rosters for current and accurate provider information.
- Maintains the highest level of customer service within the Billing Office.
- Makes recommendations to supervisory and administrative staff regarding any improvements in efficiency and/or effectiveness of the company operations.
- Maintains orderly files and workspace.
- Handles back up duties for other staff members when they are on leave as assigned by Manager.
- Corresponds, attends administrative/team meetings, assists and keeps ongoing communication with Manager.
- Handles any other duties as assigned by Relationship Manager.
Environment / Working Conditions
- Cubicles are in a well-lighted office environment.
- Cubicles are in relatively close proximity; employees must be able to concentrate with a moderate amount of distraction and noise.
- Requires use of a computer, keyboard and normal office equipment (e.g., fax machine, photocopier, etc).
- Secure HIPAA work environment
- Stable internet connection
- Windows 10V or above for applications to work
- Bluetooth headset
- Requires sitting for extend periods of time; standing; walking; stooping or kneeling; reaching with hands and arms; talking and hearing.
- Manual dexterity using computer keyboard/calculator.
- May occasionally be required to lift and/or move up to 40 pounds.