Credentialing Specialist
UCS Healthcare
Employment/Staffing | Full Time | Hybrid | West Des Moines
Posted: 11/10/23
Job Description
We have an opening for a full-time Credentialing Specialist reporting to our Chief Impact Officer. This role is perfect for a person looking for a full-time work from home position and who lives within a 2 hour driving distance to our office in West Des Moines, Iowa. We offer a competitive hourly wage and benefits package.
Job Summary: The ideal candidate will have a strong background in medical insurance credentialing for the facility and providers, with the skills necessary to ensure timely credentialing services that will provide meaningful credentialing outcomes for the group.
As part of UCS Healthcare, team members will follow all laws and regulations, including those at the Federal, State, and Local level. They will also adhere to all UCS policies and procedures, including patient confidentiality, HIPAA/ 42CFR part 2, and all CARF requirements. All team members will operate in alignment with UCS Healthcare's core values, work effectively in a team environment, provide or support patient-centered services, and strive to assist UCS Healthcare in delivering the highest level of care.
Deadline to Apply 10/24/24
Address
1300 Woodland Ave
Essential Job Functions
Establish and maintain excellent customer service relationship with UCS Managed Services Offering (MSO) network agencies and providers, and complete prompt follow up on issues.
Communicate with management regarding deadlines on tasks assigned.
Ensures all payor deadlines are met including but not limited to applications completed in a timely manner and follow up with payers.
Complete with accuracy all credentialing for facility and/or providers to ensure these are active with all appropriate insurances.
Create and/or update CAQH profile (update provider's documents -professional license, Board Cert, etc., as appropriate.
Verify OIG website monthly for all providers/staff.
Complete with accuracy all applications for credentialing and re-credentialing.
Ensure timely follow up on payer portals or through phone or email communication to ensure the credentialing process has been completed in full.
Demographic updates as needed promptly and accurately.
Serves and protects the Group and community by adhering to professional standards, company policies and procedures, federal, state, and local requirements.
Enhances credentialing department and Group reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Use resources and software available to allow efficiencies in the daily tasks/duties assigned.
Manage multiple agency credentialing; willingness to accept new groups for credentialing services.
Regular attendance is required.
Other Functions (30%):
Assist with implementation of credentialing software and on-boarding of new agencies for credentialing business.
Assist leadership to develop credentialing KPIs.
Develop, maintain, and distribute reporting as required.
Identify improvement opportunities and develop solutions to improve quality and effectiveness.
Ensure prompt communication regarding new contracts to the Billing Supervisor for completion of EFT/ERA enrollments.
Communication with insurance representatives when needed.
Communication with physicians and other clinical staff regarding credentialing updates and documents.
Gather documents and keep files organized.
Additional duties as assigned.
Minimum Required Knowledge, Education, Experience, Skills, and Abilities:
Use of Microsoft Office and Adobe computer programs.
Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
Education
Bachelor's degree preferred, but not required.
Experience
Experience in medical insurance credentialing preferred.
Experience with use of other credentialing software programs.
About the Company
As a healthcare non-profit, we put people first. We pay for a vast majority of your health insurance premium as part of our robust benefits package. We provide real opportunities for advancement and growth while doing work that makes a difference in our communities. We are inclusive and firmly believe that bringing your authentic self to work improves teams and helps our clients thrive.
If you find a better employer who can beat what is listed above, apply there. If you don't want to wait for them to catch up with UCS Healthcare, apply with us. Our team members tell us that they are grateful they did. Join us in our mission to create hope for healing and lifelong well-being.
Travel Required
0-25%
Resume Required
Yes
Contact Person
Lisa Haefner