The Medical Staff Credentialing Specialist is responsible for the timely processing of initial credentialing applications and reappointment applications for all providers who are eligible for medical staff privileges.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties and tasks may be assigned.
Maintains the US Renal Care credentialing system to ensure that it is updated in real time, data is current, accurate, and valid.
Compiles initial provider credentialing applications/ information, and sets up provider files in the US Renal Care credentialing system, and processes the initial credentialing file.
Monitors applications and follows up with providers as needed, notifies facilities and regional leadership of completed applications.
Tracks all required provider documents by their renewal dates and receive updated documents by provider prior to their expiration date.
Processes reappointment applications prior to appointment expiration date, working closely with the provider and provider office.
Processes reappointment applications for previously archived providers as requested by providers and provider offices.
Works closely with facility leadership to ensure privileges approval packets are completed and returned to the Medical Staff Credentialing office.
Provides regular credentialing status updates and reports to Manager, Medical Staff Credentialing
Provides regular credentialing status updated to provider offices and facility leadership.
Communicates professionally with all USRC staff, providers, and provider offices.
Notifies providers, provider offices, and Manager, Medical Staff Credentialing of missing or incomplete information.
Interacts with medical staff provider offices, applicants, facility leadership, and other stake holders demonstrating the highest level of customer service at all times.
Performs other duties as assigned by Manager, Medical Staff Credentialing and VP, Medical Staff Credentialing.
Regular and reliable attendance is required for the job.
QUALIFICATIONS/REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements include:
Associates Degree or equivalent experience required.Two (2) years in Medical Staff credentialing experience.Experience with VerityStream (or CredentialStream) preferred.Certified Provider Credentialing Specialist (CPCS) preferred.Must have proficient computer skills, including Microsoft Office (Word, Excel and Outlook); proficiency in USRC applications required within 90 days of hire.
Quality Analysts (Reporting) supporting the Veterans Evaluation Services (VES) administered by Maximus, make an impact everyday by reviewing case comments and sending reports to the Department of Veteran Services (VA), and discussing any issues with the QA team. They must promote and maintain a respectful, positive attitude in dealings with employees at all times. To prepare you for this role, the VES provides paid, comprehensive training which ensures all new employees provide the highest levels of knowledge and professionalism.
Process completed reports for final submission to VA through EMS
Work closely in conjunction with other Report Processing Specialists and QA Manager to submit all reports in a timely manner
Maintain thorough documentation of the process for all reports
Send “Daily Productivity” email with number of daily processed reports to QA Manager and Regional Operations Manager
Education and Experience Requirements
Additional Duties and Responsibilities
Answer emails and phone calls from quality analysts
Attend meetings as directed
Communicate and assist other departments in a collaborative effort to expedite cases
Work effectively within a team dynamic
Adapt to new instructions, requests or procedures as provided
Maintain a high sense of urgency at all times
Ensure the confidentiality of Veterans’ records
Requirements
High School Diploma or GED equivalent required
Self-starter
Advanced verbal and interpersonal skills
Advanced written communication skills, to include excellent grammar
Advanced reading and comprehension abilities
Advanced analytical skills and detail-oriented
Advanced multi-tasking skills
Advanced organizational and prioritization skills, with strong ability to meet strict deadlines with minimal supervision
Proficient typing skills
Proficient with Microsoft Word, Microsoft Outlook, Adobe Acrobat, general internet research, and beginner knowledge of Microsoft Excel.
Home Office Requirements
Internet speed of 20mbps or higher required (you can test this by going to www.speedtest.net)
Preferred Windows or Mac (no Chromebook) that is no more than 5 years old
OS for Windows – Windows 10
OS for Mac – Big Sur (11.0.1+); Catalina (10.15)
Preferred memory – 4+ GB
If you need an additional monitor, you will need to purchase separately with company reimbursement up to $120
Quality Control Billers supporting the Veterans Evaluation Services (VES) administered by Maximus, make an impact everyday by reviewing all billing payment postings and invoices. The primary responsibility will be to ensure that all charges on invoices are entered properly and accurately as well as provider reimbursement. To prepare you for this role, the VES provides paid, comprehensive training which ensures all new employees provide the highest levels of knowledge and professionalism.
Process invoices within your queue
Analyze accounts and use proper CPT codes and correct rates
Ensure accuracy in charges as well as payments to providers
Frequently communicate with facilities and other departments within the company to request any information if needed to ensure the highest quality of QA and billing
Education and Experience Requirements
Requirements
High School Diploma required; previous billing experience preferred
Knowledge of CPT codes for claim charges
Basic math skills
Self-starter with the ability to work independently
Advanced verbal and interpersonal skills
Advanced written communication skills, to include excellent grammar
Advanced reading and comprehension abilities
Advanced analytical skills and detail-oriented
Advanced multi-tasking skills
Advanced organizational and prioritization skills, with strong ability to meet strict deadlines with minimal supervision
Proficient typing skills
Proficient with Microsoft Word, Microsoft Outlook, Adobe Acrobat, general internet research, and beginner knowledge of Microsoft Excel
Home Office Requirements
Internet speed of 20mbps or higher required (you can test this by going to www.speedtest.net)
Preferred Windows or Mac (no Chromebook) that is no more than 5 years old
OS for Windows – Windows 10
OS for Mac – Big Sur (11.0.1+); Catalina (10.15)
Preferred memory – 4+ GB
If you need an additional monitor, you will need to purchase separately with company reimbursement up to $120
Daily tasks of Search Engine Evaluator will involve rating search results to the corresponding landing pages or advertisements based on a set of guidelines. Each project has a specific group of guidelines that will be explained during training in detail. Training will involve specific examples of what you can expect to see while working, this will prepare you for every eventuality. Tasks to be completed require high focus however, each task can be completed within 10 seconds to one minute. As an evaluator, must be comfortable navigating websites, search engines, and know how to find things online in general. You are ideally up-to-date on news, current events and pop culture. Our schedule is flexible to adapt to yours, although you must commit to a minimum of 10 hours per week and a maximum of 25 hours. We offer a standard base salary with a bonus rate offered if you satisfy the quality, throughput and productivity goals. If you are looking for an opportunity to participate in a long-term project in partnership with a multi-national corporation, read on!
Qualifications:
– Native level proficiency in English – Residing permanently in United States
– Strong computer skills
– Strong communication skills
– Capable of self-management and organizing your time efficiently to complete tasks
– Problem-solving skills
– Personal computer running Windows OS
– Stable, high-speed Internet connection
Employment Conditions:
– Independent contractor employment – Free training, we will be providing detailed guidelines – 10-25 hours per week, on a flexible schedule (Part-time/Work-from-Home)
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
JOB SUMMARY Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned.
• Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary, • Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. • Follow specific payer guidelines for appeals submission • Escalate exhausted appeal efforts for resolution • Work payer projects as directed • Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpayments. • Perform research and makes determination of corrective actions and takes appropriate steps to code the DCM system and route account appropriately. • Escalate denial or payment variance trends to NIC leadership team for payor escalation. Qualifications:
Conifer requires its candidates and contractors, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment activity. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements • Intermediate knowledge of hospital billing form requirements (UB-04) • Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology • Intermediate Microsoft Office (Word, Excel) skills • Advanced business letter writing skills to include correct use of grammar and punctuation.
EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job.
• High School Diploma or equivalent, some college coursework preferred • 3 – 5 years experience in a hospital business environment performing billing and/or collections
PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Ability to sit and work at a computer terminal for extended periods of time
WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Call Center environment with multiple workstations in close proximity
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