Position Title: Medical Credentialing Specialist

Supervisor: Billing Manager, Chief Financial Officer

FLSA Status: Non-Exempt

Employment Status: Part-time (24 hours a week)

Salary Range: Market Rate
Level: Paraprofessional

The Medical Credentialing Specialist will report to the Billing Manager in the Administration Department.

Summary of Duties

The Medical Credentialing Specialist will support the billing team with desktop reviews of local office activities, as well as be responsible for reviewing employers account requests to verify the accuracy of in-network providers. They will be responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by institutions, Medicare and Medicaid. This position supports several administrative tasks and the ideal candidate is someone with attention to details who can work independently. The right candidate must grasp and apply policies and procedures quickly. This position provides a high level of prompt service to the billing department, which will assist in identify potential issues and discrepancies.

Responsibilities

• Follows Oconee/DBHDD Policies and Procedures

• Reviews employer accounts ensuring timely processing of required credentialing for insurance network providers.

• Review and find in-network providers for services

• Audit provider accounts to correct creditable service and benefits as defined by local, state and federal laws.

• Communicate with appropriate parties to ensure receipt of required documentation

• Reports daily to the billing manager on current standings and daily work.

• Required to understand and utilize PECOS (online Medicare enrollment management system)

• Update each providers CAQH database file in a time efficient and accurate schedule published by CMS.

• Complete and evaluate credentialing applications.

• Work closely with the billing manager and the Chief Financial officer to identify and resolve denied authorization problems related to provider credentialing.

• Maintain accurate profiles on NPPES and CMS databases.

• Maintaining licenses for Medicaid and Medicare information.

• Knowledge of how to utilize and understand GAMMIS.

• Maintain internal provider information to ensure all login information is accurate and available

• Performs job-related duties as assigned

Education/Experience Qualifications

• Associates degree in business management

• Two (2) years of experience in credentialing

• Two (2) years of experience in a medical practice business office role

• A combination of education and experience will be accepted.

• Knowledge of CAQH, PECOS, NPPES and CMS processes

• Prior experience using GAMMIS and understands how to navigate and utilize the website.

Preferred Qualifications

• Bachelor’s degree in business management or (1) year of experience in credentialing

• Two (2) years of experience in credentialing

• Two (2) years of experience in a medical practice business office role

• Familiarity with Medical terminology

• Prior Administrative Experience

Pre-employment Requirements:

• Previous experience in mental/behavioral health field.
• Possess a valid driver’s license
• Submit to and pass a pre-employment:
• Drug screen
• DBHDD Background check
• Local Criminal Background Check
• No more than four (4) points on a seven (7) year Motor Vehicle Report
  
  • If more than (4) points an approved DDS course to reduce points must be taken.

Competencies, Knowledge & Skills

• Must be a self-starter and work independently;
• Must be highly organized and efficient;
• Good analytical skills required to interpret and analyze personnel statistics
• Computer skills required (internet, word processing and spreadsheet programs);
• Must be able to perform assignments with minimal supervision;
• Must be able to perform concentrated and/or complex mental activity with frequent involvement in complex and/or highly technical situations;
• Must be able to work successfully under stressful conditions;
• Must be able to make sound, independent judgments based on scientific and/or ethical principles;
• Must be able to comprehend and perform oral and written instructions and procedures.
• Must be able to collaborate with other multidisciplinary team members in an appropriate fashion;
• Must be capable of adapting to varying workloads and work assignments on a constant basis;
• Must have effective comprehensive reading skills, strong communication skills, written and verbal.
• Review listings for CWRO2 or 60282

License/Certifications:

• CPCS-Certified Provider Credentialing Specialist- Certificate
• AAPC- Certified-American Academy of Professional Coders -Credentialing Specialist

THIS POSITION OFFERS:

• Federal Student Loan Forgiveness
• EAP
• Flex Time