Payer Credentialing Specialist- Ohio

Thank you for considering a career at Bon Secours Mercy Health!

Position Summary:
Follows established procedures for enrolling providers with managed care plans and maintain the Council of Affordable Quality Health (CAQH) applications. Assures that procedures are followed meticulously while processing each application. Maintains high level of teamwork, customer service and consistency within the Division. Administers the many challenges faced by the medical staff and allied health professionals that result from the enrollment credentialing and re-credentialing process.

ESSENTIAL FUNCTIONS

  • Compiles, audits and expedites all information in the CAQH database and confidential credential files.
  • Facilitates all of the credentialing functions and application management.
  • Consistently updates credentialing databases and designed spreadsheets with demographic information and constructs various reports.
  • Disseminates demographic provider and practice location changes.
  • Serves as a role model to set the standards of behavior, professionalism, and outstanding customer services in all relationships with all customers – both internal and external.

Required Minimum Education:       

  • High School Diploma    

Preferred Education:

  • Associate Degree

Combination of post-secondary education and experience will be considered in lieu of degree.

LICENSURE/CERTIFICATIONS 

  • Certified Professional Medical Staff Management (CPMSM) or Certified Professional Credentials Specialist (CPCS) preferred.
  • National Association of Medical Staff Services or pursuing within 4 yrs. of hire date.

Minimum Experience:

  • 3 years of experience in a related position (preferably with medical staff services or payer enrollment). Associates degree may be accepted in lieu of experience.
  • Knowledge of insurance regulations, adjudication guidelines and credentialing policies and standards.

Required:

  • Knowledge and understanding of hospitals and healthcare trends.
  • Computer skills and experience to include database management and word processing.
  • Effective oral and written communication skills as well as strong organizational skills.
  • Attention to detail; ability to monitor and track many data elements and timelines.

Bon Secours Mercy Health is an equal opportunity employer.

Many of our opportunities reward* your hard work with:

  • Comprehensive, affordable medical, dental and vision plans
  • Prescription drug coverage
  • Flexible spending accounts
  • Life insurance w/AD&D
  • Employer contributions to retirement savings plan when eligible
  • Paid time off
  • Educational Assistance
  • And much more

*Benefits offerings vary according to employment status

Scheduled Weekly Hours:40

Work Shift: Days/Afternoons (United States of America)

Department: SS Clinical Operations – Credentialing Verification

APPLY HERE