What are the responsibilities and job description for the Delegated Credentialing Specialist I - Managed Care- Days - FT position at Memorial Hospital at Gulfport?
The Delegated Credentialing Specialist I is responsible for assisting in credentialing with the appropriate delegated insurance plans, governmental agencies and any other participating insurance plans. The Specialist I provides support in processes related to the preparation and processing of information and monitors compliance with regulatory and accrediting bodies as well as delegated rules and regulations. The Specialist I maintains accurate and up to date data within the relevant databases.
- Provides support in compiling and completing physician and provider credentialing forms for appropriate payor delegations
- Aids in the verification and documentation processes for submitted applications
- Assists with the completion of physician and provider participating contracts and credentialing files
- Collaborates with insurance plan providers and representatives to obtain and complete specific payer credentialing forms and applications
- Participates in preparing and providing information to various departments and external entities
- Communicates with appropriate billing staff regarding the status of a provider's enrollment with individual payers
- Facilitates provider-related research based on suspended claims, denial issues related to the enrollment process and other feedback opportunities
- Provides requested information to authorized agencies for audits and reviews
- Ensures compliance with delegation monitoring and oversight requirements for credentialing functions
- Collaborates with the various departments to conduct the timely credentialing delegation audits
- Participates in post-audit results meetings with insurance representatives and contributes to the resolution of any audit findings
- Attends provider onboarding to obtain additional information/signatures from providers
- Maintains and updates physicians and provider information in the applicable databases
- Maintains credentialing database and provider billing number tracking sheet
- Monitors and tracks license and certification expirations and renewals and provider information
- Maintains physician and provider directory information for departments and hospital
- Performs tracking and follow-up to ensure provider numbers are linked to appropriate entity and location
Education:
- High School or GED
Experience:
- 1 year of experience with p ayor credentialing or related
Skills:
- Strong verbal and written communication skills
- Data entry with minimal errors
- Seeking solutions using appropriate methodologies