Credentialing Associate

Job Description

Credentialing Associate

Job purpose
To perform the operation of enrollment for all eligible providers in the Center and adhere to all enrollment requirements working with our third party vendors.
Duties and responsibilities
The Credentialing Associate will have a dual reporting structure to both the Vice President of Administrative Services and Senior Director of Clinical Operations. The position may be fully remote once completely trained and will be responsible for maintaining active status for all providers by successfully completely initial and subsequent enrollment packages as required by for all Insurance Carriers accepted by FHCHC. The selected candidate will be expected to work proactively with respect to audits and reporting and will perform related duties within the billing department related to revenue cycle.

• Typical duties include but are not limited to:
  • Maintain individual provider/site files to include up to date information needed to complete the required governmental and commercial payer credentialing applications including, but not limited to; CAQH, PECOS, NPPES, and CMS databases to include name changes, office location and demographic changes, etc.
  • Complete both initial credentialing and re-credentialing/revalidation requests for both providers and sites to commercial payers, Medicare, and Medicaid either directly or through third party contractor.
  • Maintain internal provider grid with enrollment updates shared with Director and VP on a weekly basis.
  • Update EHR vendor with enrollment updates.
  Work closely with the Revenue Cycle Team in areas including but limited to:
  • Provide resolution of denials or authorization issues related to provider credentialing and/or contracting which will include being a liaison with outside organizations.
  • Ensure that all payment and posting delivery maintenance systems are set up properly for optimal billing department functioning including to and not limited to: Electronic Remittance Advice and Electronic Funds Transfers
  • Update all contact information specific to contact and fax numbers with carriers.
  • Maintain carrier websites – Organizational Enrollment/Maintenance.
  • Maintain fee schedule database including an assembled grid with the top 100 codes used by our organization by carrier.
• Interact with representatives from health plans to answer inquiries, clarify requirements
•  Work closely with credentialing manager to ensure prompt response to time sensitive requests and will assign tasks to credentialing manager as needed.
•  Perform other necessary duties as required by FHCHC within the scope of this position.
• Meet weekly with credentialing manager and monthly with VP and Director.
• Update and upload 340B program files monthly.

Requirements:

•  Bachelor’s degree required. A combination of education and experience may be substituted for the degree requirement.
•  Experience & proficiency with Microsoft Office. Excellent oral and written communication skills.
•  Three or more years of related experience, an understanding of physicians and physician specialties required, Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle, Certified Provider Credentialing Specialist (CPCS) and the Certified Professional in Medical Services certificates desirable but not required.
•  The selected candidate will be detailed oriented with the ability to maintain strict confidentiality; be highly organized & detail oriented and have the ability to work independently on multiple tasks simultaneously and meet hard deadlines.
  Direction of Others
  None
  Remote work disclosure: Based on organizational need FHCHC reserves the right to discontinue or revise remote work arrangements. FHCHC will provide advance notice to ensure a smooth transition to onsite reporting.