Description

A. POSITION SUMMARY

Supervised by the Director of Revenue Cycle Management, this position is responsible for coordinating the day-to-day credentialing operations to ensure deadlines are met and Providers are credentialed, privileged, and enrolled with all applicable insurance companies. All credentialing activity must be conducted in accordance with FCCH bylaws/policies/procedures, the Joint Commission standards, and State and Federal regulations to assure that only qualified professionals provide care at FCCH. The position includes support for the Credentialing Specialist and diligent follow up with external insurance organizations/other entities to ensure credentialing as a billable provider.

B. ESSENTAIL DUTIES AND RESPONSIBILITIES

• Maintain provider credentialing tracking to include all appropriate dates, license numbers, and insurance and billing information.
• Maintain Provider enrollment tracking to include filling out applicable applications and insurance follow-up.
• Maintain facility credentialing deadlines; Complete applications and coordinate appropriate responses to insurer requests for facility credentialing and re-credentialing.
• Ensure work standards are of the highest level and manage to meet applicable internal and external deadlines.
• Participate in recurring presentations of provider staff credentialing/licensing status to various committees, board members and others, in partnership with clinical directors.
• Maintain excellent communication with all FCCH providers and correspond as needed to obtain required information from/respond to inquiries received, by letter, telephone, and/or e-mail, on position-related activities.
• Communicate with tact and diplomacy with diverse groups of people including staff, providers, and insurance companies on behalf of the organization. 
• Research provider credentialing denials: corresponding with insurance provider reps and resolving issues timely to ensure payment for services.
• Manage credentialing department correspondence, following up timely and ensuring the needs of the organization are met.
• Perform other duties, as assigned.

Requirements

C. MINIMUM EDUCATION AND EXPERIENCE

• High school degree or GED;
• At least 4 months of directly related experience in credentialing & privileging services;
• Functional working knowledge of/expertise in using Microsoft Office Suite;
• Billing experience for multiple disciplines; medical primary care, dental and behavioral health;
• Billing experience in multiple reimbursement methodologies such as PPS (Prospective Payment System), FFS (Fee for Service) third party billing agreements. Including In-Network and Out of Network claims submissions and aged accounts receivable

D. PREFERRED EDUCATION 

• Bachelors degree 

E. KNOWLEDGE, SKILLS AND ABILITIES REQIRED

• Medical terminology;
• Ten-key and keyboarding skills;
• Strong organizational and interpersonal skills including the ability to deliver difficult information positively;
• Extensive knowledge of PC applications including Excel and Word;
• Knowledge of RBRVS and insurance (i.e. Medicare, Medicaid & FQHC) reimbursement regulations;
• Knowledge of and familiarity with compliance programs, and ability to cooperate fully and comply with laws and regulations;
• Knowledge of principles and practices of credentialing
• Effective oral and written communication skills
• Excellent interpersonal skills;
• Ability to analyze and solve problems;
• Knowledge of database management; 
• Excellent follow-through skills; 
• Knowledge of laws, regulations, methods, and techniques in area of specialty;
• Knowledge of credentialing administration principles and procedures; 
• Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures;
• Convincing evidence of a service orientation;
• Knowledge of customer service standards and procedures; 
• Program planning and implementation skills;
• Ability to foster a cooperative environment;
• Ability to communicate effectively, both verbally and in writing, with various internal and outside entities;
• Ability to exercise good judgment in appraising difficult situations and in making appropriate decisions;
• Ability to maintain confidentiality of records and information;
• Ability to work with computer software provided for/designed to support the position;
• Ability to work in a team setting with a variety of First Choice personnel;
• Knowledge of and familiarity with compliance programs, and ability to cooperate fully and comply with laws and regulations;

F. PHYSICAL CHARACTERISTICS/WORKING CONDITIONS

A person in this position has sufficient time to complete most tasks although under pressure depending on organization demands. There are frequent opportunities to relax from any physical exertion or to change position in work activities.

1. Physical Effort and Dexterity: Good dexterity to operate personal computer, and basic office equipment. Moderate physical activity expected. Requires handling of average-weight objects up to 25 pounds or standing and/or walking for more than four (4) hours per day.

1. Machines, Tools, Equipment required to be operated: office machines and personal computers for word processing, data entry and retrieval.

1. Visual Acuity, Hearing, and Speaking: Must be able to communicate clearly and accurately for work and safety compliance, including ability to read computer monitors.

1. Environment/Working Conditions: Work is mostly inside a clinic in a controlled environment. Normal clinic safety precautions and practices are required. Position may require travel throughout the Albuquerque metropolitan area. Work regularly scheduled Monday-Friday, although weekends may be required to meet deadlines.

This description lists the major duties and requirements of the job and is not all-inclusive. Applicants may be expected to perform job-related duties other than those contained in this document and may be required to have specific job-related knowledge and skills