Specialist, Credentialing
Specialist, Credentialing
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Job Description
Welcome to Ovation Healthcare!
At Ovation Healthcare weve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence we help rural healthcare providers fulfill their missions.
The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcares vision is to be a dynamic integrated professional services company delivering innovative and executable solutions through experience and thought leadership while valuing trust respect and customer focused behavior.
Were looking for talented motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives in a collegial atmosphere of professionalism and teamwork.
Ovation Healthcares corporate headquarters is located in Brentwood TN. For more information visit .
GENERAL SUMMARY:
Credentialing Specialists ensure that medical staff members maintain current credentials and licenses to work legally in their field or specialty. These specialists monitor upcoming renewal dates and work with medical staff to advise them of the required steps to maintain their credentials. They also review information on potential new employees to make sure all required licenses and credentials are current before hiring. Credentialing specialists often work independently. This requires the specialist to be able to manage their workloads effectively to meet set deadlines. Strong computer skills are necessary for the input and maintenance of data as well as for performing research regarding licensing or credentialing requirements in their area. Interaction with other medical professionals office personnel and the public is standard. A Senior Credentialing Specialist will hold 1 years of seniority working as a Credentialing Specialist II and will be familiar with majority of carrier requirements per state.
DUTIES & RESPONSIBILITIES:
Monitor credentials and licenses by keeping them up to date with CAQH and all insurance payers that require.
Complete and submit enrollments with insurance carriers
Follow up on application status and release claims when complete
Complete the recredentialing enrollments for providers when necessary
Maintain communication with insurance carriers on new enrollment processes
Communicate with clients/providers regarding payer enrollments
Update and maintain credentialing software and CAQH profiles for credentialing enrollments
Assist other team members when necessary
Manage validation lists to ensure payment of claims are made in a timely manner
Maintain attestations for payer portals as needed
Update credentialing software and QR Guides to maintain accuracy of data and processes for enrollments
Work with Payers to resolve claim issues pertaining to provider enrollments
KNOWLEDGE SKILLS AND ABILITIES:
Proficient knowledge of Excel Word Outlook and Teams
Organizational Skills
Ability to multi-task
Strong Communication Skills
WORK EXPERIENCE EDUCATION AND CERTIFICATIONS:
Provider Payer Enrollments
Highschool Diploma or GED
WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:
100% Remote
TRAVEL REQUIREMENTS:
0%
Required Experience:
Unclear Seniority
Employment Type
Full-Time
