Credentialing / Payer Enrollment Specialist – Part-time, Non-Exempt
Description
Applicants must reside in the US.
This position acts as a liaison between Company’s clients and the payers, making sure that all accounts are credentialed and/or set up correctly with payers so that claims process correctly. This department has a key role in onboarding new accounts, and its processes are critical to the success of all accounts.
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Schedule/Availability
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25-35 hours per week
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Available during reasonable daytime hours to answer staff questions and contact payers
Responsibilities
- Takes major lead in onboarding new accounts
- Pays close attention to New Provider Onboarding tracker; accepts meetings with new clients to discuss their setups with payers
- Ensures that payer enrollment, credentialing, contracting, and demographics work for new accounts is progressing in a timely manner
- Becomes proficient in credentialing, contracting and demographics processes
- Ensures that providers are credentialed in as efficient a manner as possible; suggests improvement to protocols as needed
- Works to facilitate effective communication with providers to obtain information needed for payer enrollment, credentialing, contracting and demographics
- Applies for new contracts as requested by providers; reviews existing contracts and suggests changes as needed
- Attempts contract renegotiations for providers with existing contracts that are outdated or have poor fee schedules
- Ensures that proper customer service is given to all accounts in a timely manner and that department tasks do not fall through the cracks; provides clients with regular updates on work being performed
- Protects provider specific information in strictest confidence
- Utilizes Modio Health Software
- Stays current with updates to Modio
- Utilizes the software as much as possible to prevent human error and optimize efficiency/communication with payers
- Effectively communicates with manager all concerns regarding workload and the ability to complete work
- Asks for help when overwhelmed
- Makes sure the schedule and assigned workload is reasonable
- Informs manager when tasks fall behind by more than 5 days from department protocols, so that help can be assigned before the situation worsens
- Is extremely transparent with manager about all concerns so that issues can be addressed quickly
Knowledge and Skills
- Two+ years’ experience in contracting and credentialing work with payers
- Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with clients, LBS staff, and insurance companies
- Experience with Modio Health software is preferred
- PECOS experience Experience with Microsoft Office products
- Knowledge of ICD-10, CPT, and HCPCS codes
- High level of professional communication; written and verbal
- Typing 60+ words per minute with high accuracy
- High level of ethics and integrity in all areas
- Able to prioritize work and meet deadlines
- Able to establish relationships with multi-levels of staff appropriately
- Flexibility to work in an extremely fast-paced and dynamic environment
- Ability to work independently and within a team
- Strong organizational skills and attention to detail
Hiring organization
Job Location
Remote work from: United States Only
Employment Type
Part-time
Date posted
September 21, 2023
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