- Responsible for credentialing, enrolling, and maintaining approximately 300 providers in assigned state/territory; provides support to team members outside of assigned state/territory, as needed
- Obtains all necessary credentialing information and documentation required for payer enrollment process and verifies completed standard applications for assigned providers within 30 days of receiving the onboarding application
- Tracks and reports progress in credentialing database and provider files by adding status notes and filing payer correspondence
- Follows up with payers on outstanding credentialing issues in a timely and consistent manner; resubmits applications in a timely manner as needed
- Communicates all credentialing and payer enrollment approvals to field and internal departments; responds to emails related to payer enrollment within 24-48 hours
- Notifies payers of professional and clinical staff updates such as service locations, periodic roster updates, name changes, official notices, etc., on an ongoing basis
- Audits provider rosters upon payer requests
- Education:
- High school diploma or equivalent required
- High school diploma or equivalent required
- Work Experience:
- Minimum 1 year of payer enrollment experience required; 2-3 years experience preferred
- Minimum 1 year of payer enrollment experience required; 2-3 years experience preferred
- Certification/Licensure:
- Preferred, but not required
- Preferred, but not required
- Knowledge and Technical Skills:
- Knowledge of CAQH/Proview, NPPES/I&A Management System and PECOS preferred
- Knowledge of Medicares enrollment process, including enrollment forms, preferred
- Proficiency in Microsoft 365 required
- Works effectively both independently and in a team setting
- Ability to manage multiple responsibilities and tasks based on their importance and urgency
- Attention to detail and excellent organizational skills required
- Ability to read, write and speak English proficiently
- Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stoop/kneel/crouch, travel around the office, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding.
- Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
- Consistent with a standard office environment, noise level is low with little to no extraordinary environmental factors.
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Credentialing Coordinator - Oak Brook, United States - AthletiCo
1 week ago
Description
Position Overview:
Greater Purpose and Core Values:
Athleticos Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.
Position Summary:
The Credentialing Coordinator reviews applications, prepares verification letters, and contacts clinical staff and insurance carriers to ensure that all active providers have completed applications and credentialing/re-credentialing information on file with the applicable contracted payers.
Essential Duties and Responsibilities:
Qualifications:
Language Skills:
Physical Demands:
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
Work Environment:
Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
