JOB PURPOSE:
The Credentialing Specialist reports is responsible for timely and accurate credentialing and enrollment processes associated with government and/or commercial payers; ensuring compliance with regulatory standards department processes; maintaining accurate records within the licensing and credentialing database. This position involves daily contact with both internal and external customers.
Key Responsibilities:
- Complete complex credentialing forms accurately and compile requested documentation for packet submission.
- Research and validate government requirements and regulations to prepare documentation to submit with Medicare and state Medicaid enrollment applications.
- Research, validate, and complete full cycle execution of all necessary business licenses including, but not limited to: City, County, State, Bedding and HME/ DME licenses and specific requirements.
- Maintain and monitor records database with all pertinent credentialing and business requirements, completely and timely.
- Meet all deadline submissions with companies, commercial payers, Medicare and state Medicaid agencies.
- Provide excellent customer service to all internal and external customers of the operations.
- Organizes and maintains file system and files correspondence and other records.
- Makes copies/scans correspondence or other printed materials.
- Prepares outgoing mail and correspondence, including e-mail and faxes to meet department deadlines.
- Utilize the Numotion Leadership Principles to perform the job with integrity, compliance, and values consistent with Numotion’s mission.
- Adheres to the policies and procedures of Numotion.
Other Functions:
- Perform related duties as required.
The duties listed above are intended only as illustrative of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar or a logical assignment to the position.
Required Skills
REQUIRED QUALIFICATIONS AND SKILLS:
- Exemplary attention to detail and diligence.
- Ability to work in a fast-paced environment, effectively manage multiple priorities and work independently.
- Possess excellent computer and communication skills; Microsoft Office Suite and excel with is required.
- Able to use technology to optimize efficiency and effectiveness.
- Able to seek out resources to find solutions.
- Written and verbal communication, listening and organization skills is necessary.
- Listens well and retains instructions; accepts constructive feedback from manager.
- A proven record of being consistent with attendance and prompt arrival at work and meetings.
- Ability to perform job with integrity and values consistent with the Numotion mission.
- Ability to work over eight hours in a workday, and over 40 in a work week, as necessary.
- Ability to read, comprehend and follow written and verbal instructions.
Required Experience
REQUIRED EXPERIENCE:
- Experience in Credentialing, Insurance and/or Insurance knowledge and background
- Associate’s degree or equivalent from a two-year college or technical school; or two to three years of related work experience and/or training or equivalent combination of education and experience.
- General knowledge of our business model and experience working with commercial payers, Medicare, state Medicaid agencies and license facilities.
PREFERRED COMPETENCIES AND:
- Prefer 1-2 years credentialing experience with knowledge of Medicare, state Medicaid’s and state licensure requirements.
- Certified CPCS preferred.
- Credentialing experience within a durable medical equipment environment preferred.