Employment Type:
Full time
Shift:
Day Shift
Description:
The Credential Reimbursement Specialist is directly responsible for the efficient administration of credentialing providers with all contracted payers.
Performs support duties and act as a liaison between physicians, clinic managers, ownership company and insurance payers to ensure a smooth and efficient credentialing process.
Responsible for the audit and recovery of reimbursement deficiencies between the payer and Saint Alphonsus Medical Group.
Collaborates with and takes direction from the Director Clinic Business. Confirms billing guidelines and claim form requirements, corrects accounts as needed, identifies related problems.
Audits accounts identified as incorrectly paid by the health plan and follow accounts until resolution.
Audits accounts based on contractual agreements.
Understands how to run selective reports in Next Gen, to identify accounts for audit based on contract, account type, procedure or diagnosis, service type, service date or any other criteria.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:
High School graduate or GED required.
Any combination of education and experience or any other combination of education, training or experience that provides the required knowledge, skills and abilities.
Problem identification and problem-solving skills required.
HIGHLIGHTS AND BENEFITS:
When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho.
We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one.
Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop.
We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow.
Visit www.saintalphonsus.org/careers to learn more!
MINISTRY/FACILITY INFORMATION
Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.
Top 15 Health Systems in the country by IBM Watson Health.
The region's most advanced Trauma Center (Level II).
Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.