Third Party Payor Credentialing Specialist - Miami, United States - Banyan Health Systems

Description

Come and join and amazing established growing healthcare company with a 53 year history

Banyan Health Systems has been serving Miami-Dade and Broward Counties since 1970. We provide quality, individualized care to each of our patients. Our system of integrated health services brings together specialized psychiatric care, primary care, pediatrics, geriatrics, and an extensive program of residential and outpatient substance abuse & behavioral health services under one umbrella. At Banyan Health Systems, we believe when individuals are healthy and strong, our communities are better for it.

We are currently looking for individuals who share our mission of integrating primary and behavioral health care while providing access to all individuals. We focus on providing quality and compassionate care in order to assist our patients in living their best life. We are dedicated to the endless pursuit of excellence and treat everyone with dignity, humanity, and respect.

If you share these beliefs and want to join us to make a difference, please take some time to read the post below.

VERY COMPETITIVE COMPENSATION AND BENEFITS

Third Party Payor Credentialing Specialist:

Position Summary:

Reporting to the RCM Manager, this position will work with Third Party Payors to register clinicians with their programs and support the credentialing and recredentialing process for applicants, members, and facilities of the clinical staff at Banyan Health System. The Credentialing Specialist will collaborate with each clinical staff office and site by professionally assisting health care providers in verifying their credentials and obtaining appropriate privileges. Participation in projects initiated to facilitate the credentialing and verification process. The Credentialing Specialist will work under supervision of the RCM management. This position also requires integral communication with patients, insurance companies, department administrators, physicians, and other departmental staff to ensure the ideal patient experience across the health system. Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Health System Shared Services vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized.

Responsibilities:

• Work with Third Party Payors to register clinicians with their programs
• Present clinicians to the Third Party Payors
• Track and recredential clinicians with payors as needed
• Process initial credentialing and re-credentialing applications.
• Knowledge of National Practitioner Data Bank (NPDB) and The Council for Affordable Quality Healthcare (CAQH).
• Ability to maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Understanding of credentialing systems such as MD Staff.
• Maintains knowledge of current health plan and agency requirements for credentialing providers.
• Ability to meet strict deadlines.
• Strong ability to multi-task.
• Working knowledge of insurance collections and claims to assist on any denials due to credentialing issues/concerns.
• Maintains knowledge of applicable Federal, State, and local laws and regulations, Standards of Conduct, as well as Health System policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Assist in month end projects and processes.
• Respond to all inquiries from patients, physicians or departmental customers (both internal and external) within 1 business day of initial request.
• Identify, report, and communicate accounts receivable trends to RCM management.
• Small- and large-scale projects for the RCM department.

Education:

Associates degree preferred. Work experience may substitute degree (i.e., 2 years of experience for 1 year of education)

Knowledge:

• Advanced knowledge of medical and insurance terminology
• Advanced Knowledge in credentialing both facility and providers of all levels.
• Strong ability to multi-task and work under pressure to meet deadlines.
• Credentialing experience in a healthcare setting.
• Working knowledge of applicable Federal, State, and local laws and regulations desired
• Working knowledge of credentialing software, MDStaff preferred.
• Experience working with multiple payer websites and portals.

Work Experience:

• Minimum 2-3 years of experience in credentialing, healthcare revenue cycle, medical office, hospital, patient access or related experience
• Experience in behavioral health preferred.

Banyan Health Systems 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.