1 Credentialing Specialist Job in Dover, DE
Bayhealth is Hiring a Credentialing Specialist Near Dover, DE
SHIFT: Days
General Summary:The Credentialing Specialist (BHMG) accurately maintains demographic data in the provider enrollment/credentialing software for Bayhealth Medical Group providers; completes provider enrollment applications, follows up with health plans to expedite participation approval by each health plan, assists insurance personnel with resolving provider enrollment denials, and communicates provider enrollment status to appropriate personnel. The Credentialing Specialist also works with Medical Staff Services personnel in processing credentialing requests for Bayhealth Medical Group (BMG) providers.
Responsibilities:
- Perform CAQH (Council for Affordable Quality Healthcare) re-attestations.
- Coordinate with the medical billing service company to enter referring physicians’ information into AR system.
- Obtain new provider’s CV, demographic data, and required documents for enrollment/credentialing purposes. Enter and maintain this data in the provider enrollment software. Prepare provider applications including mailing or faxing enrollment applications as required.
- Submit notice of changes and follow up with the contractual insurance carriers and clients (account managers) regarding provider enrollment/termination/relocation status.
- Update appropriate provider enrollment stat matrix & daily project list. Send new provider requests to the medical billing service company. Generate provider reports upon request via the provider enrollment software. Work to assure appropriate charge capture and authorization is received.
- Collaborate with supervisor/manager and BMG management team to resolve account issues & billing issues as requested within revenue cycle and in appropriate information systems.
- Coordinate with the medical billing service company the hold and release of charges based on enrollment status with carrier, and perform follow up on held activity. Report any significant delays to management.
- Assist with completion of vendor EDI agreement forms required for electronic claims filing, and initial ERA agreement forms to receive electronic remittance with the Finance Department and the medical billing service company.
- Assist coding personnel with resolving provider enrollment denials. Coordinate with insurance carriers to maintain most current applications and processes for enrollment. Research enrollment requirements for new clients/carriers/provider types, and keep information current. Map enrollment applications.
- Analyze processes for areas of exposure to the organization, and recommend corrective action.
- Review all County & City Occupational Licenses; DE Medical Licenses; State Controlled Substance Certificates; Federal DEA Certificates to ensure up to date.
- Reporting: Monitor and report Physician Exception hold status and Hold/Release requests with Medical billing service company. Review FTE Provider Count Report on a monthly basis and provide information to the necessary parties.
- Cross train with various departments workflow as requested.
- All other duties as assigned, within the scope and range of job responsibilities.
- Education: High School Diploma or GED
- Credential: None Required
- Experience: At least three (3) years’ experience in an office setting requiring well-developed spreadsheet and word processing skills.
- Education: Associate Degree
- Credential: None Preferred
- Experience:
https://apply.bayhealth.org/join/
Job Summary
Full Time
Ancillary Healthcare
$41k-52k (estimate)
10/09/2023
07/02/2024
bayhealthdevelopment.com
EMERYVILLE, CA
<25
2015
<$5M
Ancillary Healthcare
Related Companies
About Bayhealth
BayHealth is a UCSF Health and John Muir Health joint venture company focused on infrastructure development supporting the needs of the Canopy Health accountable care network, and serving as a joint strategic investment vehicle in support of the UCSF/JMH affiliation. We are deeply committed to value creation in the Canopy Health network and our shared vision with UCSF/JMH for innovation in patient experience, access, affordability and quality of care.
The job skills required for Credentialing Specialist include Leadership, Onboarding, Decision Making, Process Improvement, etc. Having related job skills and expertise will give you an advantage when applying to be a Credentialing Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Credentialing Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Credentialing Specialist positions, which can be used as a reference in future career path planning. As a Credentialing Specialist, it can be promoted into senior positions as a Compliance Manager - Healthcare that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Credentialing Specialist. You can explore the career advancement for a Credentialing Specialist below and select your interested title to get hiring information.
If you are interested in becoming a Credentialing Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Credentialing Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Credentialing Specialist job description and responsibilities
A certified professional credentialing specialist ensures that staff members of a facility maintain licenses, training, and certifications based on federal and state law.
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A credentialing specialist can have certificates that will prove useful to their field.
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Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.
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Credentialing specialists are part of an organization's administrative staff; they review medical policies, process contracts, and facilitate audit reports to validate that certified medical professionals comply with credentialing procedures.
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Credentialing specialists will also ensure that their employer meets state, federal and other regulations for quality of care.
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Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Credentialing Specialist jobs
Credentialing specialists can often find work with a high school diploma or the equivalent.
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Some employers strongly prefer credentialing specialists who have a Certified Provider Credentialing Specialist (CPCS) credential.
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While an associate degree may not be required for a position as a credentialing specialist, some employers may prefer applicants with a two-year degree.
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Make Use Of Advanced Software For Monitoring.
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Stay Updated with the Coalition for Affordable Quality Healthcare's Credentialing Program.
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Step 3: View the best colleges and universities for Credentialing Specialist.
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