Responsible for assisting with all aspects of the health insurance credentialing, re-credentialing and contracting processes for all medical providers who provide patient care. Job Responsibilities: Completes provider (professional) credentialing and re-credentialing applications; monitors applications and follow-up as needed in an outpatient psychiatric/mental health setting. Compiles and maintains current and accurate data for all providers and practices. To include but not limited to, copies of current state licenses, DEA certificates, malpractice coverage, corporate contracts and any other required credentialing documents for all providers. Applies for additional payer contracts and fee schedule increases as requested by leadership. Maintains knowledge of current health plans and agency requirements for credentialing providers. Tracks license and certification expirations for all providers to ensure timely renewals. Ensures practice addresses are current with health plans, agencies, and other entities. Audits health plan directories for current and accurate provider information. Accept and process all requests from payers for credentialing information/updates/new contracts and products in a timely manner. Evaluating the credentials of prospective employees to determine whether they meet requirements for employment in a particular field Manage the provider on-boarding credentialing and maintain all records and communication with insurance companies Provide training, implementing new policies and procedures, as well as ongoing credentialing updates to the operations team. Ensure accuracy of information sent to insurance companies and completes tasks in a timely manner. Weekly credentialing meetings to go over any issues that have arisen and go over upcoming tasks. Updates and maintains active and accurate payer portals, completes payer attestations in a timely manner. Maintains confidentiality of provider information. Works collaboratively with RCM and Operations, other duties as assigned. This is a full-time position that will work Monday - Friday. Experience and Skills: Associates or Bachelors degree preferred. 1-3 years of medical office work or relevant health insurance and credentialing experience. Knowledge and understanding of the health insurance credentialing and contracting process. Knowledge of professional and medical billing, credentialing, and contracting. Ability to organize and prioritize work and manage multiple priorities. Excellent verbal and written communication skills including letters, memos and emails. Excellent attention to detail and ability to recognize potential issues and proactively problem solve Ability to research and analyze data. Ability to work independently with minimal supervision. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Proficient use of Microsoft365, payer directories, and credentialing sites. Expert in Microsoft Word and MS Excel Ability to quickly learn new software programs, i.e. Medallion
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