Insurance Credentialing Specialist - Full-Time

This Full-time Insurance Credentialing Specialist will work 80 hours bi-weekly.

Monday - Friday, 8:00a - 4:30p

Benefit Package that includes Medical/Dental/Vision insurance, Life Insurance, Short and Long Term Disability,

403B Retirement Savings Program and Paid Time Off. 

Job Summary

Supports, and is responsible for incorporating into job performance, the Frederick Health (FH) mission, vision, core values and customer service philosophy and adheres to the FH Compliance Program, including following all regulatory requirements and the FH Standards of Behavior.

In collaboration with the Payer Credentialing Enrollment Program Coordinator, the Specialist is responsible for payer enrollment functions for providers of Frederick Health Medical Group.  Responsibilities include, but are not limited to, gathering data, filing enrollment data via paper/electronic means, follow-up with payer(s) on enrollment status and request various data updates or additions to the Expanse system.

 Essential Functions:

• Completion of health care professionals credentialing and re-credentialing applications.
• Data entry of new applications in the credentialing Spreadsheet.
• Maintain working knowledge of State and Federal regulations related to credentialing.
•  Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, etc based on health plan requirements and company credentialing policies.
• Maintain the credentialing spreadsheet and ensure up-to-date information is obtained at all times.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Prepare and scan credentialing/re-credentialing files and other credentialing documentation into CAQH and into Credentialing folders on drive.
• Provide support to physicians, physician office staff, health plan contacts and company departments as necessary.
• Perform other related duties as assigned by management.
• Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and departmental policies.
• Maintain privacy and confidentiality at all times.

 Required Knowledge, Skills and Abilities:

• Proficiency in the use of Microsoft Office.
• Excellent verbal and written communication skills in order to effectively interact with providers, employees and Senior Leaders. Must demonstrate the ability to follow verbal and written instructions.
• Attention to detail, with the ability to analyze and determine the type of data needed to complete various types of insurance enrollment functions.
• Must possess organizational skills and demonstrate ability to manage time, deadlines, multiple request and priorities, maintain productivity and exercise good judgment with minimal supervision.
• Must have the ability to apply policies and procedures regarding data security and confidentiality to prevent inappropriate release of patient information.

 Minimum Education, Training, and Experience Required:

• High School Diploma or GED required.
• Prior professional billing, collections or credentialing experience required.

 Patient Contact

Must demonstrate and maintain current knowledge and skills in providing appropriate care/contact for patients in the following age groups:

                 Performance of job does not require patient contact

 Physical Demands:

Sedentary - Light Work - Lifting up to 15 pounds on an infrequent basis (less than one lift every three minutes).  While work is mostly done sitting, a certain amount of walking or standing is often necessary.

 Ergonomic Risk Factors:

Repetition:  Repeating the same motion over and over again places stress on the muscles and tendons.  The severity of risk depends on how often the action is repeated, the speed of the movement, the required force and muscles involved.

 Awkward Posture:  Posture is the position your body is in and its effect on the muscle groups that are involved in the physical activity.  Awkward postures include repeated or prolonged reaching, twisting, bending, kneeling, squatting, working overhead with your hands or arms, or holding fixed positions.

Working Conditions:

1. Bloodborne Pathogens Exposure Risk:  Category C – NO exposure to blood or body fluids.

Reporting Relationship:

Reports to Director