Job Responsibilities:

• Gathering and accurately tracking all documents needed for each individual situation to credential or transfer already credentialed providers under group for billing to be processed. This includes Physician licenses, DEA certifications, malpractice coverage, collaborative, and supervision agreements, etc.
• Ensures provider data is accurately updated in the database and reaches out to practice manager and/or providers for current documentation as required.
• Verifying current documents, such as licensure, DEA, etc., any ECFMG confirmations or processes and social security documents to submit with paperwork.
• Accurately completing and submitting applications to each insurance carrier that is participating with IRMC/IPG/PPG/COSM/Butler/ITT/MNK including; Medicaid, Medicare, Highmark, Aetna, Cigna, Devon, Highmark Wholecare, Behavioral health (Carelon, CCBH, & Optum) Humana, Multiplan, Railroad Medicare, UMWA Funds, United Healthcare, and UPMC.
• Advanced knowledge of the credentialing processes to submit clean applications with all requested materials for efficient approvals or updates.
• Following up on submitted applications until approvals or updates have been completed.
• Advanced knowledge of CAQH system to retain quarterly attestations or complete initial profiles for new providers and extenders.
• Helping billing department with any denied patient claims being refused for provider participation reasons. Release claims from credentialing holds in Cerner Revenue Cycle.
• Updating Billing and Administration on each provider as they become approved with each insurance to process their claims.
• Complete and process any recredentialing requests for providers to continue participation with said insurances.
• Advance knowledge of CLIA guidelines for requests on making any practice changes to add/delete tests or location/directorship updates. Complete new CLIA and permit applications.
• Assist with both Urgicare center's payor applications as requested from hospital. Knowledge of the difference between hospital and provider practice applications.
• Work directly with IRMC/PAH Medical Staff office to share and retrieve provider documentation.
• Updating all rosters on a quarterly basis and demographic changes as needed for IRMC/IPG/PPG/MNK/ITT/COSM/Butler.
• Flexibility to adapt with daily needs that occur for our physicians and the offices, according to their priority level.
• Process insurance portal requests in a timely and accurate manner.

Knowledge, skills, Abilities and Personal Characteristics:

Knowledge of:

Advanced knowledge of computer hardware and software programs (Microsoft products)

Advanced knowledge of copier, faxing and other types of office equipment

Advanced knowledge of insurance portals for setting up and maintaining users

Team dynamics and the process of building consensus

Interpersonal communication skills for working with personnel in tense situations

Qualifications:

High school diploma or equivalent is required. Prior experience and or certification in
credentialing preferred. Four or more years of medical office or hospital experience required.

Advanced Organizational skills, multitasking, and prioritization.

Proficient and advanced communication skills (written and verbal).