- Work with contracted providers to meet all the credentialing service expectations outlined in their contract
- Review and screen initial and re-appointment credentialing applications for completeness, accuracy, and compliance with Federal, state, local and University regulations, guidelines, policies, and standards
- Complete the processes to enroll and credential providers (e.g., physicians, facilities, physician assistants, nurse practitioners, etc.) with insurances, while meeting payor criteria
- Knowledge on how to re-credential existing providers
- Gather and maintain current data and documents for all providers in an organized manner
- Follow up with clients and insurances for timely credentialing process(es)
- Clearly and effectively communicate with providers, Operations Managers and insurance companies handling basic questions dealing with the day-to-day operations of credentialing and enrollments
- Accurately review and update, if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information
- Monitor files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies
- Prepares and provides information to internal and external customers as appropriate
- Respond to emails timely and effectively
- Must maintain professional appearance and demeanor at all times via video calls
- Other duties as assigned
- High School Diploma or GED
- Thorough understanding of carrier policies and procedure of their credentialing processes
- High attention to detail and accuracy
- Strong organization skills
- Ability to dive deep and problem solve
- Ability to thrive in a dynamic environment
- Ability to stay focused on multiple tasks
- Able to work independently and take ownership of work with little to no supervision
- Ability to work collectively and cooperatively with management, co-workers, healthcare providers, patients, and insurance carriers
- Excellent written and verbal communication skills for effective and professional interaction with clients, patients, and insurance carriers
- Self-awareness to maintain composure and show continual empathy, concern, and courtesy in every interaction
- Computer literate with proficiency in web-based products and the ability to learn new applications easily
- Experience working remotely, preferred
- 2 years of contracting & credentialing experience with medical practice office operations protocols, preferred
- Familiar with any credentialing software
- Extensive knowledge of Microsoft Excel, Microsoft Word, Google Docs, and Google Sheets
- Family atmosphere
- Independent, yet collaborative, work environment
- Remote work schedule with some flexibility
- Accrued Paid Time Off (can be used for sick or vacation time)
- Health insurance
- Life insurance
- 7 Paid Holidays (regardless of whether the holiday falls on a regular work day or not)
- 401K with up to 4% match (after 1st year of employment)
- A range of additional optional benefit offerings (short term disability, vision, dental)
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Credentialing Specialist - Kernersville, United States - Petra Management Consultants LLC
2 weeks ago
Description
Job Description
Job DescriptionWHO ARE WE?
Petra Management Consultants, LLC is a trusted partner for healthcare providers seeking expert guidance in business operations, practice management, and other key development services including, but not limited to, physician licensing, contract negotiation, and credentialing services. As industry pioneers, we've forged a path of excellence by partnering with our sister company, PriMed Processing, LLC, a unique, boutique-style medical billing service. Through our combined expertise and dedication, we empower our healthcare providers to prioritize exceptional patient care, with the confidence that their business needs are being managed as an extension to their practice. Our incredible and caring team, where the average tenure is over 7 years, serves as advocates and liaisons between the healthcare professionals, their patients, and the insurance carriers.
WHO ARE YOU?
This position is perfect for the person who thrives in a dynamic environment and relishes in taking the necessary, proactive steps towards resolving any complex issues efficiently. With a knack for diving deep into details, you enjoy the process of problem-solving and investigation and appreciate crafting clear and concise communication. Your exceptional organizational skills enables you to manage tasks and projects with precision and efficiency, ensuring all details are accounted for and deadlines are met. You embrace the opportunity to passionately advocate on behalf of the provider to ensure all their contract and credentialing business needs are met. Collaboration is second nature to you, and you excel at synthesizing information quickly so it can be communicated with ease in a timely fashion. Most importantly, you are going to love being part of the Team at Petra Management Consultants, LLC because you delight in and take pride in your work–it is not seen as "just another job," yet as meaningful work that makes a real difference.
WHAT YOU WILL DO... (RESPONSIBILITIES)
WHAT YOU NEED... (REQUIREMENTS)
IT WOULD BE GREAT IF... (PREFERENCES)
WHAT WE OFFER... (BENEFITS)
