Credentialing Specialist- Medical Payer

HealthPoint Family Care is a private medical practice dedicated to patient wellness. The organization provides adult and pediatric medical, dental, mental health, substance abuse treatment, obstetrics and gynecology, and vision services. We offer walk-ins, same day appointments, evening and weekend hours for the convenience of our patients. We have locations in Northern and Central Kentucky.

Benefits:

• Retention bonus of $1,500 paid at 18 month of employment- Additional retention bonus's up to $4,000
• Two free sets of HealthPoint scrubs
• Tuition Reimbursement for up to $1,000 a year.
• Nine paid federal holidays
• Birthday off paid in addition and not counted towards PTO
• Generous Paid Time Off
• Wide array of benefit plans such as health, dental, vision, flexible spending accounts, Safe Harbor 401K Plan, long term disability and group/voluntary life insurance plans.

We are looking to add an additional Credentialing Specialist to our growing organization. While not all inclusive some of the responsibilities of the position would include the following tasks:

• Accurately tracks, records and collects necessary data from various sources to complete applications, renewals, revalidations and terminations.
• Responsible for coordinating the credential processes practitioners and facility in our growing healthcare practices.
• Maintains Provider credentialing files, initiates NPDB database inquiries, maintains NPPES and CAQH provider databases, and timely completion of Provider enrollment applications.
• Credential providers and facilities with Medicare, Kentucky and Ohio Medicaid and private payers for medical, mental health, women's health, dental and vision services.
• Tracks application status through timely follow-up to ensure enrollment.
• Responsible for processing of provider payor applications, initial, re-applications and attestations.
• Understands Medicare, Medicaid and commercial payor application process and EDI agreements.
• Maintain Credentialing files (paper and computer)
• Coordinates and participates in all phases of credentialing/re-credentialing profile process.
• Tracks and logs credentialing status routinely with participating networks.
• Review, update, maintain and report fee schedule for various payors within Group assigned.
• Aggressively collects, coordinates, reviews and documents performance data, which includes quality and utilization activities, member complaint data for re-credentialing purposes.
• Revenue Cycle projects as assigned.
• One year of experience in direct credentialing including primary source verification and completion of Medicare/Medicaid/commercial payer and hospital privileging applications. Applicants with less than one year experience will be considered with a training plan.
• Knowledge of Ohio and Kentucky Medicaid and Medicare credentialing requirements and systems.
• Proven methods for file maintenance and tracking required.
• Must be professional and detail oriented.
• Strong verbal and written communication skills.
• Intermediate level skills required in Microsoft Outlook, Word and Excel.
• Training in medical billing or a related field a plus