Job description
Overview:
WHY JOIN THE #PTSFAM?
See what the #PTSFam is up to on Facebook, Instagram, Twitter and LinkedIn.
The
Payor Enrollment Specialist is responsible for obtaining and maintaining payer participation with government and commercial health plans and assisting in enrollment issues as they relate to payer enrollment and claims payment.
The Credentialing Specialist will work closely with HR, the clinicians, Clinic Directors and staff to collect all items needed to obtain and maintain all payer participation.
Essential Functions:
Required Skills & Abilities:
Required Credentials:
The Credentialing Specialist will work closely with HR, the clinicians, Clinic Directors and staff to collect all items needed to obtain and maintain all payer participation.
Essential Functions:
- Manage the completion, submission and re-credentialing of provider enrollment applications
- Track current status of applications, follow up as necessary and document activity in an accurate and timely manner
- Prepare the CAQH for newly affiliated and existing providers to include re-attestation
- Research and resolve provider related enrollment issues and coordinate with team members of various departments when applicable
- Maintains confidentiality of provider information
- Maintain the physician’s files for revalidation of Medicare via PECOS
- Maintain and update provider files and rosters including but not limited to internal provider and/or location data, individual CAQH profiles, payor databases, NPI database and Medicare database, and any other as needed
- Assist providers with completion of applications and credentialing paperwork
- Advises management team of any potential delays in a providers’ credentialing and works with billing operations staff in resolving billing issues related to payor credentialing issues
- Review provider credentialing files and work with providers to obtain the necessary missing, incomplete and expiring items
- Proficient in Microsoft Excel
- Stays abreast of current health plan and agency requirements for credentialing providers
- Communicates appropriately with Physician’s regarding credentialing and insurance enrollment for new providers and new practices with government and c commercial insurance payers
Required Skills & Abilities:
- Ability to type 60 words per minute preferred
- Physician and Payor Credentialing Experience
- Great customer service skills
- Strong interpersonal, oral (includes telephone skills) and written communication skills
- Ability to manage multiple streams of work simultaneously using good planning, organization, multi-tasking, and prioritization in order to meet deadlines
- Complete understanding of medical reimbursement and terminology.
- Ability to work with disabled individuals
Required Credentials:
- High School Diploma.
- Minimum two years of experience credentialing for Managed Care Insurance Enrollment, Medicare (PECOS) and Medicaid
- Working knowledge of CAQH Proview, Verity Stream, Echo 1 app
- Knowledge of payer credentialing process, ability to organize and prioritize work and manage multiple priorities, excellent verbal and written communication skills, ability to research and analyze data, work independently, and establish and maintain effective working relationships essential
- Advanced skills with Microsoft applications which may include Echo/One App, Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
WHY JOIN THE #PTSFAM?
PT Solutions starts with a true love of physical therapy and fuses that passion with science and training to create an unmatched standard of care for patients. We love our work, and that enthusiasm is evident in all we do, both in the clinic and in the community. With points of service across the United States, we work in partnership with our patients and are committed to keeping them in motion throughout all phases of injury and healing. That dedication creates authentic connections with patients and makes PT Solutions the best place to redefine recovery.
See what the #PTSFam is up to on Facebook, Instagram, Twitter and LinkedIn.
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