Strivant Health partners with physician practices to improve revenue cycle operations by optimizing people, processes and technology. We provide best in class Medical Billing, Collections, Call Center, Credentialing and Analytics that are all designed to focus on maximizing our provider clients’ revenue. This allows our client providers to stay focused on the practice of medicine, rather than the business of medicine. We have worked with over 4,000 providers representing 25 different specialties and over 30 technology platforms in our 20+ years of business.
Senior Credentialing Specialist - Physician
LOCATION: This position is 100% REMOTE
Hours: Monday - Friday. 8:00 AM - 4:30 PM, full-time, Central Time Zone
Status: Full-Time, Benefits Eligible
The Senior Credentialing Specialist Remote ensures timely credentialing and re-credentialing of all physicians associated with Strivant Health clients as they impact the revenue cycle management. The Senior Credentialing Specialist maintains credentialing documentation and filing system in either an electronic or manual format. They ensure that client physicians follow relevant industry regulations. They may also keep records related to insurance contracts and staff credentials. They often must keep in contact with staff and insurance companies to insure they have all the necessary documents and inform them of any changes in contracts and policies that would affect usual business. They ensure credentials meet regulatory agency requirements and adhere to Medical Staff Bylaws, Rules and Policies. They enter practitioner data quickly and accurately. They are responsible for identifying insufficient credentialing documentation and forwards documentation edits to the appropriate internal teams, providers, clients or insurance carriers to resolve issues.
This position holds additional duties with respect to research, and participation in root cause analysis and identifying process improvements. As well as participation in employee training and quality audits, with possible exposure to credentialing software/database management and tracking logs. The Senior Credentialing Specialist represents Strivant Health as the credentialing expert liaison in client meetings and communications. They coordinate and drive all credentialing vendor communications and oversee the audit results of the all-vendor output. They may assist in special projects as assigned my management.
- Performs primary credentialing of all assigned new applicants to the client medical staff
- Assists Manager and Strivant leadership in matters related to Medical Staff Bylaws, Rules, and Policies
- Manages Provider Staff database to ensure accurate, timely and complete documentation of provider credentials
- Updates and reports on regulatory survey process including TMHP CMS, TMB, and DEA
- Applies and validates medical staff standards, compliance statutes and procedures
- Fosters positive working relationships between the Medical Staff and the Strivant Health staff
- Represents Strivant Health as the credentialing expert liaison in client meetings and communications.
- Coordinate and drive all credentialing vendor communications and oversee the audit results of the all-vendor output.
- Ensures effective working relationships and communication between the Medical Staff Office and other Strivant Health departments
- Provides the highest standard of privacy and confidentiality in matters involving, but not limited to, providers, patients, coworkers, and the client
- Enforce regulatory compliance and quality assurance at our client centers.
- Preparing and maintaining reports of credentialing activities such as accreditations, insurance enrollments, memberships, or facility privileges with affiliated providers.
- Ensure that all information meets federal and state guidelines when processing applications.
- Keep client provider’s accreditations up to date and assists auditors.
- Resolve daily credentialing edits
- Contact various insurance carriers to resolve credentialing edits
- Responsible for reviewing accounts, verifying, and updating credentialing data and leaving detailed notes
- Meets or Exceeds Department Productivity standards
- Meets or Exceeds Quality Assurance standard of 95% or higher
- Analyze and resolve moderately complex credentialing reconciliations, reviews entry to prevent errors
- Maintains a desk as well as serve as just-in-time staffing, working inventory for team members that may be absent or backlogged.
- Research and obtains required documents to resolve misdirected credentialing issues
- Assist in employee training and mentorship, when needed
- Independently identifies root cause issues and effectively resolve complex credentialing issues; categorize error reasons and coordinate with management or other team members to ensure process improvements are completed
- Completes reports and resolve high priority credentialing issues
- Provide technical assistance, mentoring and training to other team members, when needed
- Provides periodic quality assurance checks
- Assist in special projects assigned by management.
- Participate and attend meetings, training seminars and in-services to develop job knowledge.
- Respond timely to emails and telephone messages from the staff and management and credentialing contract vendors.
- Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions.
- Incumbents working from home must comply with Strivant Health Remote Access Policy and follow all Strivant Health policies.
- Incumbents may be required to work onsite at a Strivant Health location during their initial training period or periodically as requested for meetings or future training sessions.
- Performs other related duties as required or requested.
- High School diplomas or equivalency
- A minimum of 3 years of experience in provider/physician credentialing
- 2 years CAQH exp. required.
- Experience supporting large provider networks including multiple facilities/locations
- Prior experience with both facility and insurance enrollments preferred
- Prior experience with multi-state credentialing preferred
- Prior experience in regulatory survey process including TMHP CMS, TMB, and DEA, preferred
- Prior experience validating medical staff standards, compliance statutes and procedures, preferred.
- Experience working and maintaining credentialing tracking logs, software or database systems required, CPCS or CPMSM preferred
- Ability to effectively use a personal computer and working knowledge of spreadsheet application to perform data entry and analysis (must be proficient in Excel and Word).
- Communication and interpersonal skills necessary to interact with internal/external customers in various circumstances.
- Ability to collaborate effectively in a team setting to maximize quality and efficiently of operations.
- Excellent organizational and time management skills. Ability to establish and meet deadlines while managing multiple priorities.
We look forward to reviewing your resume. No agencies, please.
Search tags: Physician Revenue Cycle, RCM, Accounts Receivables Rep, Patient Account Rep, Patient Service Rep, Account Rep, Medical Coding, Medical Credentialing, Medical Referrals, Medical Billing, Physician Billing, Provider Access.