May Institute is an established nonprofit that wants to continue to make an impact. We are looking for a Credentialing Specialist to join our team. May Institute is a team of professionals committed to leading the continuous evaluation of organizational systems, through a team-oriented approach, in a collaborative effort to ensure practices are safe, effective, efficient, ethical, comply with established laws and industry standards, meet the needs and expectations of our customers, and promote the ongoing improvement of service outcomes and quality. Credentialing Specialist reports to the Billing Manager and would be working directly with our Home, School, and Center-based division.
WHO YOU ARE:
·An individual with a high degree of organization, attention to detail, follow through, and independence.
·The ability to interact effectively with employees at all levels in the organization and external stakeholders are critical to success in this position.
·This position plays an integral role in ensuring that payments for services rendered are received in a timely fashion, and that process related to contracting and credentialing are as effective and efficient as possible.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
· Responsible for the accuracy and timeliness of the entire credentialing process of obtaining, reviewing, submitting, tracking provider applications and re-credentialing applications.
·Act as liaison to HR/Talent Acquisition and clinical practice supervisors on matters related to credentials, licensure, and provider numbers for billing third-party insurances for new and current employees.· Maintains quarterly audits on re-credentialing process of insurance contracts, insurance rosters, and CAQH status for clinical staff. · Interacts with internal departments to ensure systems have the proper insurance information (fee schedules) and that clinician credentialing is aligned with the terms of the payor contracts.·Works closely with senior third-party biller and Billing Manager for resolution in insurance denials for provider credentialing as well as contract/fee schedule discrepancies.·Carry out all job responsibilities and communications with respect and dignity and in accordance with May Institute policies and procedures. · A working knowledge of relevant local, state and federal laws and the related requirements of varying funding sources.
·At least three to five years experience·Third-party insurance experience a must·Bachelor’s degree preferred.·Must understand the nature and importance of confidential calls/situations and the ability to handle with discretion.·Excellent oral skills.·Demonstrated ability to learn new concepts, processes, procedures and computer applications quickly and thoroughly.·Strong computer skill using Microsoft Office programs - Excel, Word, PowerPoint, and database software. ·Knowledge of and skill in working with electronic records management software.
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