Credentialing Specialist

SUMMARY:

The Credentialing Specialist is responsible for assisting in all aspects of the licensing and credentialing of the Company. The Specialist will process applications on behalf of the Company in order to ensure compliance and completeness of licenses and agreements with Medicare, state Medicaid agencies, federal, state and local licensing agencies and private health insurance companies.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Include the following as well as other duties and responsibilities, which may be assigned.

• Assist with the maintenance of complete and accurate documentation regarding the Company, its facilities/operations, its ownership and its management to ensure proper and complete completion of licensing and credentialing applications and insurance agreements;
• Assist with timely responses to requests for information from federal, state and local agencies and private insurance companies regarding the Company’s licensing and credentialing obligations;
• Assist with research, maintenance and coordination of all federal, state and local licensing requirements
• Accurate and timely completion of initial, renewal applications as well as process organizational changes via notification and/or application;
• Assist with the maintenance of the Company database to ensure accuracy of all licenses and agreements with federal, state and local organizations and private health insurers
• Assist with the completion of all revalidation or re-credentialing requests from Medicare, state Medicaid agencies and private health insurance companies;
• Prepare all licensing and applications for new locations of the Company in order to obtain Medicare licensing, state licensing and accreditation
• Contact insurance companies to initiate participation into their DME provider networks, including the completion of letters of interest and applications,
• Maintain the Company’s database of Provider Insurance contracts,
• Notify all pertinent Company personnel regarding new insurance contracts, fee schedules, and updating the Company’s Payer database
• Other duties as assigned

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must possess the ability to: interact professionally and ethically with team members, all levels of management, government agencies and commercial payer personal; handle multiple tasks simultaneously; provide clear, concise oral and written directives/communications; quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner. Strong attention to detail and follow through is required. Meticulous organization and filing skills. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE:

1. High School Diploma
2. Associate or Bachelor’s degree, or relevant healthcare experience
3. Analytical skills required, attention to detail, organized

TRAINING:

Our industry is a highly regulated industry, and because of that and our commitment to providing the best in class products, services, and support, we require ALL employees to complete the following training programs prior to the marketing and promotion of our products, services, and support systems:

1. Anti-Kick Back Training
2. Fraud, Abuse, and Waste Training
3. HIPAA Training
4. Systems Training

CONTINUING EDUCATION:

To continue to be best in class within our industry, we require all employees to participate in ongoing education to maintain / increase their competency or in the event the team member changes responsibility within the company