Credentialing Specialist

Owensboro Health - 42301
April 1, 2021
CREDENTIALING SPECIALIST Professional Non-Clinical Hours: M-F 8AM - 4:30PM Days - Full-time Paygrade/Wages/Salary Info: OH 2013-73 - 40087A
Job Summary Responsible for the timely submission of provider enrollment applications to government and commercial payers and for performing the tracking and follow-up required until provider numbers are established and linked to the appropriate Owensboro Health Medical Group (OHMG) entity. # Job Responsibilities Performs tracking and follow-up to ensure provider numbers are established and linked to the appropriate OHMG group entity in a timely manner. Ensures that established provider numbers are communicated to professional billing in order to release pended claims and to clinic managers for patient scheduling. Assists finance department in identifying patient population needs and targeting payers for contracting. Manages each provider#s Council for Affordable Quality Healthcare (CAQH) and National Provider Identifier (NPI) accounts. Establishes close working relationships with providers, office managers, professional billing, and payer contacts. Participates in on-boarding and network representative meetings. Maintains provider enrollment information within the credentialing database and pulls reports for hospital administration, marketing, professional billing staff, and clinic directors/managers as needed. Upon receipt of applications ensures all required information is contained therein, assembles the information, and prepares credentials files for submission to government and commercial payers. Identifies and reviews credentialing red flags with OHMG managers and directors. Maintains calendar of provider licensure, certificate of insurance, and network expirations. Submits Annual Disclosures of Ownership (ADOs) and re-validations to Medicare and Medicaid on all providers and practices. Manages the process for credentialing and re-credentialing of all OHMG providers per the time schedule established by each contracted network. Assists OHMG providers, clinic directors, and office managers in a thorough understanding of the credentialing/enrollment processes and policies. Qualifications Bachelor#s degree or higher in Business Administration required upon hire OR Bachelor#s degree or higher in Healthcare Administration required upon hire OR Bachelor#s degree or higher in related field required upon hire A combination of education, training and experience may be considered in lieu of degree. No experience required No licensure/certification/registration required Skills and Attributes Requires critical thinking skills and decisive judgment. Works under minimal supervision. Must be able to work in a stressful environment and take appropriate action. Physical Demands Standing: Occasionally Walking: Occasionally Sitting: Frequently Lifting 0-25 lbs: Rarely Lifting 25-75 lbs: Never Lifting over 75 lbs: Never Carrying 0-25 lbs: Rarely Carrying 25-75 lbs: Never Carrying over 75 lbs: Never Pushing/Pulling 0-25 lbs: Rarely Pushing/Pulling 25-75 lbs: Never Pushing/Pulling over 75 lbs: Never Climbing: Rarely Bending/Stooping: Rarely Kneeling: Rarely Crouching/Crawling: Rarely Reaching: Occasionally Talking: Frequently Hearing: Occasionally Repetitive Foot/Leg Movements: Never Repetitive Hand/Arm Movements: Frequently Keyboard Data Entry: Frequently Running: Never Vision: Depth Perception: Frequently Vision: Distinguish Color: Frequently Vision: Seeing Far: Frequently Vision: Seeing Near: Frequently Owensboro Health Core Commitments INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers. RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community. TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future. INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health. SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do. EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.