What are the responsibilities and job description for the Credentialing Specialist position at Ohio County Healthcare?
Principal Responsibilities and Competencies:
o Working with Payer Representatives to problem solve ongoing issues and stay educated on any updates from the payer.
o Participating in educational activities and staff meetings when necessary.
o Credentialing new providers/facilities with all payers
o Maintaining providers/facilities credentials and keeping files up to date
o Contacting providers/payers when needed to acquire information needed for credentialing purposes
o Resolving any credentialing issues
o Maintain CAQH updates
o Keep up with KY Medicaid portal, PECOS, revalidations for providers and clinics
o Revalidations every 3 years with payers
o Review payer rosters
o Communicate/collaborate with hospital credentialing staff
o Maintaining confidentiality and adheres to all hospital policies, including HIPPA guidelines.
o Participate in bi-weekly Onboarding meetings
o Other duties as assigned.
Work Environment: Office setting
Physical Demand: Walking, frequent sitting at desk, occasionally stair climbing, occasionally lifting, looking at computer screen, writing.
Schedule: Monday through Friday; 40 hours.
Travel: Occasionally travels from off site business office to hospital or clinic locations
Qualifications:Required: High School diploma or equivalent (May be allowed to sign a GED agreement to obtain within 6-months)
Preferred experience in insurance billing and follow-up and credentialing.