Job Description
Job Description
Job Description
Title: Credentialing Specialist
Reports to: Director of Contracting and Credentialing
FLSA Classification: Hourly, Non-exempt
Commonwealth Pain & Spine is a pain management network dedicated to improving the lives of our patients by treating their pain with the utmost respect and providing them with the most innovative, safe, responsible, and clinically proven pain relief possible.
Our team of best-in-class physicians, administrators, and staff empathizes with the needs of our patients. We recognize that their pain is exhausting and debilitating and limits their quality of life. Relief from chronic pain is achievable in various degrees through our intelligent and multimodal team-based approach. Our entire team is committed to providing levels of patient satisfaction and overall clinical outcomes that far exceed the expectations of the medical community, referring physicians, and our customers.
Benefits: - Competitive compensation
- Comprehensive Health/Vision/Dental insurance options
- Great PTO plan PLUS Paid Holidays
- 401k and matching available
Commonwealth Pain and Spine is an Equal Employment Opportunity Employer!
Job Summary: This role involves managing updates and changes to provider and facility information in relevant systems, ensuring accurate setup and processing to support claims and contractual agreements. Responsibilities include compiling, verifying, and analyzing data, resolving issues, and providing support to internal and external teams.
Responsibilities - Compile appropriate information to make requested credentialing, contractual, and demographic updates and changes related to provider or facility.
- Accurately set up providers in provider systems of record (assign provider numbers and communicate with provider community) to ensure appropriate claims payment in accordance with contractual language.
- Compile, analyze, and verify the required information for provider enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record.
- Communicates, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems of record.
- Research, respond to, analyzes and resolve complex claims issues related to provider setup and provider eligibility on a in a timely manner.
- Provides cross-functional support and serves as subject matter resource or second tier resolution to internal and external provider teams (i.e., Contracting, Provider Relations, etc).
- Recommend and participate in process improvement opportunities for Network Management Operations.
- Identify system problems, gaps or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives and solutions.
- Accountable for complying with all laws and regulations associated with duties and responsibilities.
- Create resolution documents to address provider issues and increase provider satisfaction. Utilizes probing and problem-solving methods to resolve all inquiries/requests. Identifies, understands, and anticipates providers
- Facilitate accurate financial claims payment and provider directory processes.
- Represent the client to external provider communities and internal stakeholder groups.
- All other duties as assigned.
Required Skills - Two years of customer service, credentialing, enrollment and billing, claims and/or insurance operations experience is required.
- Demonstrated knowledge of insurance services and operations.
- Exceptional communication and interpersonal skills to interact effectively and tactfully with all levels of employees, management staff, patients, vendors, and the public
- Strong computer and phone skills, including Microsoft Office Suite experience
- Responds timely to requests, emails, voicemails, etc.
- Ability to handle multiple simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner
- High integrity, including maintenance of confidential information
- Regular and reliable attendance
- Exercises professional judgment and demonstrates good problem-resolution skills
- Eagerness and ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on a variety of tasks and projects.
Education: - High school diploma or general education degree (GED) required
Physical Requirements: The physical demands of this position will include sitting and standing with occasional light to medium lifting. An employee must meet these requirements to successfully perform the essential duties of this job. Reasonable accommodation will be made in accordance with ADA rules and regulations.
Job Tags
Hourly pay, Work at office,