CREDENTIALING SPECIALIST

Job Details

Job Location

Glen Rock, PA

Position Type

Full Time

Travel Percentage

None

Job Shift

Any

Description

American Endovascular a leader in the fields of Amputation Prevention, Endovascular, & Interventional Radiology is seeking a Credentialing Specialist to join our team. This is an exciting time to join our team, as our company continues to grow!

Essential Responsibilities Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification. Ensures that the credentialing requirements for governmental agencies and commercial managed care insurers/networks are met and managed appropriately and timely. Submits and follow up on credentialing to all contracted commercial payors and government agencies timely and accurately Enters and maintains data in the contracting and credentialing database, according to established data entry rules and policies. Performs database queries and reports as needed. Ensures that demographic changes are promptly reported to all contracted managed care companies and governments agencies. Maintains managed care contract files (paper and electronic) and department databases for contracts and credentialing. Acts as a liaison with third-party commercial payers to provide necessary documentation and information needed for managed care contracting to proceed Report on performance and activities on a weekly basis. Update and maintain contract database.

Qualifications

High School Diploma/GED required. Minimal five years experience in a managed care credentialing and contracting preferred. Will consider candidate with professional high level administrative duties. Comprehensive knowledge of the managed care industry, with specific emphasis on ancillary credentialing and contracting requirements. Ability to communicate effectively both verbally and in writing with internal staff, management, and managed care companies in order to achieve the necessary results required in the credentialing and contracting process. Actively engages in supporting department contracting and negotiation efforts as needed. Maintains in reportable form contract terms, rates, policy. Participates in over and under payment reviews to determine if contracts are being honored and reports to VP of Payer Relations. Assists internal departments, specifically the Reimbursement Team with questions and issues and offers a solution when viable.Performs other duties and works on special projects as requested.