Overview
Provider Credentialing Specialist - Iowa. We are seeking a Provider Credentialing Specialist to work in the urgent care/primary care setting. Your main focus will be providing high-quality, efficient provider credentialing. You will obtain licensure and credentials from providers, verify past credentials, and ensure the billing process runs smoothly.
Responsibilities
* Enroll providers with the necessary payors and the clearinghouse to ensure claims can be billed correctly.
* Handle contracting, revalidating Medicare and Medicaid enrollment, CAQH, and any re-credentialing maintenance.
* Collect and confirm provider information to process and file reports with accrediting and licensing agencies, and maintain a database of provider information.
* Coordinate with the billing department to ensure processes are in place to detect non-compliant or questionable claims.
* Review clearinghouse and claims data for rejections; identify and correct credentialing issues.
* Maintain, review, and update provider credentialing with all payors; review prior credentialing applications for errors and correct as needed.
* Assist with denials due to credentialing issues.
* Maintain MODIO provider certification system.
* Maintain CAQH profiles for all providers.
* Update payor panels and insurance eligibility websites (e.g., Availity, Trizetto).
* Assist with onboarding new hires with HR to ensure candidates complete and submit all required documents prior to onboarding.
* Ensure that provider medical licenses, board certifications, DEA, and other pertinent information are renewed prior to expiration.
* Manage and maintain relationships with payors to improve revenue; perform other contracting and maintenance needs required by payors.
* Possess proficiency with MS Word and MS Excel; knowledge of HIPAA; ability to work independently and as part of a team.
* Able to multi-task, prioritize, and meet deadlines. Self-motivated and able to stay on task.
* Working knowledge of healthcare insurance rules and guidelines; understanding of RHC credentialing rules and guidelines.
* Maintain regular and sustained attendance; knowledge of office equipment (fax, scanner, copy machine); excellent computer and data entry skills.
Schedule
* Varying 8-hour shifts
* Varying Monday to Friday
Education and Experience
* Associate Degree preferred
* Certified Professional Biller or Certified Professional Coder preferred
* 2+ years’ experience in a medical office with experience in claims, billing, insurance, and medical records is an asset
* 2 years of credentialing required
Equal Opportunity Statement
QuickVisit is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is our intent to maintain a work environment that is free of harassment, discrimination, or retaliation because of age (40 and older), race, color, national origin, ancestry, religion, creed, sex, sexual orientation, pregnancy, physical or mental disability, genetic information, marital status, AIDS/HIV status, veteran status, uniformed servicemember status, or any other status protected by federal, state, or local laws. The Company is dedicated to the fulfillment of this policy in regard to all aspects of employment.
Seniority level
* Entry level
Employment type
* Full-time
Job function
* Health Care Provider
Industries
* Medical Practices
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