CME - Credentialing Spec

About the role

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team!

Responsibilities

• Oversight of the credentialing matrix and assistance with progress to get providers credentialed with Government payor first.
• Liaison to administrative assistants as well as providers with regards to the accurate and complete credentialing and revalidation process to ensure the financial viability of the organization in accordance with State & Federal reimbursement guidelines.
• Aid in credentialing commercial insurance carriers for all providers within CPSST practicing.
• Ensure accurate and timely updates of addresses with payors.
• Enroll providers into Medicare, Medicaid and commercial insurance plans under CPSST and conduct revalidations including updating locations and documentation.

Qualifications

• Maintain utmost level of confidentiality.
• Adhere to DCH policies and procedures.
• Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Review documents submitted by providers (doctors and NPs) for accurate information.
• Aid providers with credentialing revalidations as needed for CPSST providers.
• Interact with CBO Director and Coding Manager frequently or as needed to ensure compliance and accuracy in credentialing role.
• Report to CBO Manager regarding job responsibilities/functions and DCH policies.
• Interact with providers.
• Demonstrate understanding of security and confidentiality of data and information.
• Maintain a professional demeanor.
• Aid in training of other team members and serve as a resource for other staff members.
• Maintain flexibility in scheduling to ensure optimal departmental operations.
• Evidence of understanding and demonstration of DCH philosophy, values, and mission through interactions with others.
• Maintain and ensure confidentiality of financial patient records and follow HIPAA regulations.
• Perform assignments and other work-related tasks as designated in a timely and professional manner.
• Respond to all inquiries in a timely and professional manner.