Credentialing Consultant - Physician Services
Category: Clerical
Facility: Genesis Healthcare System
Department: Physicians Services
Schedule: Full Time
Shift: Day Shift
Hours: 80 bi-weekly / Mon - Fri 8-5pm - flexibilty
Contact Information: Contact: Human Resources
Job Details:

JOB SUMMARY

 This position is responsible for collecting and maintaining credentialing and licensing documents from providers, submitting and tracking payor credentialing and re-credentialing within set deadlines, and various other tasks to assist with the physician and non-physician provider start-up process. 

 

ESSENTIAL DUTIES

 1.       Prepares and submits payor credentialing and re-credentialing applications for Genesis HealthCare System providers.

2.       Communicates with providers during the credentialing process to request credentialing materials and answer provider questions.

3.       Reviews applications and supporting documents for accuracy and completeness.

4.       Follows up on status of applications, maintains detailed log of all pending and completed work, and provides up-to-date credentialing status reports.

5.       Interacts extensively with physician and non-physician providers, insurance payors, and clinical department staff to facilitate physician enrollment and to maximize reimbursement for services rendered.

6.       Follows up with providers and their staff in a timely manner regarding their credentialing process and enrollment status with payors.

7.       Completes data entry for, and resolves issues related to providers’ CAQH and NPI information.

8.       Conducts research as needed during the credentialing process.

9.       Assists with various projects as assigned by the supervisor to assist with physician services.

 

QUALIFICATIONS

 1.       High School Diploma or equivalent required. 

2.       Minimum two (2) years of credentialing and managed healthcare experience.

3.       Knowledge of provider enrollment processes, requirements for commercial insurance companies, and CMS Federal and State Guidelines related to enrollment policies.

4.       Familiarity with group and provider documents, i.e. medical licenses, medical school practices, board certifications, etc.

5.       Must possess excellent organizational skills and be extremely detail-oriented.

6.       Ability to work independently and make sound and timely decisions.

7.       Effective problem solving, organizational, and communication skills.

8.       Effective interpersonal skills with the ability to interact with individuals from differing backgrounds and from all organizational levels.

9.       Ability to handle in-depth research to find specific websites, guidelines, and instructions.

10.    Excellent computer and analytical skills with proficiency in MS Windows applications.

 

WORKING CONDITIONS/PHYSICAL REQUIREMENTS

 The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1.       Work is performed in an office setting.

2.       This position will require travel to each office throughout the week, with frequent contact while off-site

 

This description reflects in general terms the type and level of work performed.  It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

 




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