Job Description

Credentialing and Contracting Specialist Location Tampa, FL : JOB SUMMARY The primary responsibilities are to perform administrative tasks pertaining to credentialing new providers and maintaining credentials for current providers at Sunshine Pediatrics, along with reviewing current rates and payments from insurance payers.
Completes practitioners' applications/reapplications
Responds to requests from insurance companies for information/documentation
Follows up with insurance companies and hospitals regarding status of practitioner's applications
Notifies insurance carriers when a practitioner leaves the practice
Notifies insurance carriers when a new practitioner joins the practice
Tracks information to promote speed of processing
Processes change of addresses for each practitioner/practice location
Manages renewals of medical licenses, DEA's, occupational licenses for all practitioners
Maintains the NPI (National Provider Identifier) and CAQH (Council for Affordable Quality Healthcare) data bases
Maintains a current electronic insurance grid identifying the credentialing status of all practitioners for contracted payers and government agencies
Maintains a resource file on each practitioner
Maintains a current chart overview of the payment rates received from insurance payors and proactively reviews payments on a daily basis
Identifies potential changes in payments from payors and notifies insurance to correct reimbursement
Scans/Faxes and Medical Records as needed.
JOB REQUIREMENTS
High school graduate or GED equivalent
Minimum 1 year experience in credentialing
Strong aptitude for customer service and telephone etiquette
Organized, detail-oriented, and diligent work ethic
Proficient in Word ,Excel, Adobe (PDF), Outlook
Knowledge of CAQH and I&A, PECOS/CMS applications
Credentialing Specialist Certification (CPCS) Preferred
KNOWLEDGE, SKILLS, AND ABILITIES
Working knowledge of CAQH (Council for Affordable Quality Healthcare) and I&A, PECOS/CMS applications
Excellent written, oral communication, analytical skills, and customer relations
Ability to organize, prioritize, and effectively work on multiple projects at one time
Ability to read and communicate effectively in English. Additional languages preferred
Ability to communicate in a professional manner, able to counsel/teach customers, train co-workers, and positively contribute to marketing/public relations
Ability to respond to common inquiries or complaints from patients, regulatory agencies, or members of the medical and business community
Must be able to work in an environment where production goals are set to be achieved

Job Tags

Full time,

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Credentialing and Contracting Specialist Job at Sunshine Pediatrics of Florida, Tampa, FL

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