Credentialing Specialist

Location: Garner, North Carolina US

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Job Number: 3325

Position Title: Credentialing Specialist

External Description:

We are hiring a motivated, detail-oriented Credentialing Specialist to join our team in Garner, NC!  If you are looking rewarding career in a setting that promotes professional growth and teamwork, apply now!!

Job Summary:

The Credentialing Specialist coordinates and performs a variety of administrative duties that are required for credentialing, re-credentialing and enrollment of both the clinicians and office locations. The Credentialing Specialist interacts with Insurance Carrier Contacts, Senior Management, Revenue Cycle, IT, Clinical and Front Office Staff, Recruiting, HR and others department as necessary to facilitate the credentialing and enrollment processes to maximize reimbursement.

Reports to: Director of Revenue Cycle Management

Essential Functions:

  • Maintain and perform a warm, friendly and welcoming relationship with all Pivot staff, all medical and non-medical professionals, vendors and visitors.
  • Prepare, submit and follow up on all initial payer applications for providers and office locations
  • Prepare, submit and follow up on all re-credentialing applications for providers and office locations
  • Contact and/or respond to requests for verification of credentials, current licenses etc. ensuring credentialing and licensing processes are completed timely and notifications are sent timely
  • Prepare, submit and follow up on revalidation requests for providers and office locations.
  • Review provider credentialing files and work with providers to obtain the necessary missing, incomplete and expiring items
  • Escalate non-responsive staff to Manager or Director with documentation of requests
  • Advises management team of any potential delays in a providers’ credentialing and works with billing office staff in resolving billing issues related to payer credentialing issues.
  • Track current status of applications, follow up as necessary and document activity in an accurate and timely manner
  • Provide updates to regional directors, directors, managers and front office coordinators to ensure proper billing and update each billing database once provider billing numbers are obtained
  • Maintain and update provider files and rosters including but not limited to: internal provider and/or location roster lists, individual CAQH profiles, payer databases, NPI Database and Medicare database and any other as needed
  • Maintain consistent contact with providers to ensure that expectations are clear and requirements are completed in a timely manner
  • Establish and maintain professional relationship with insurance providers, client contacts and credential personnel.
  • Ensure all PHI (Protected Health Information) remains confidential and is kept in a secure location at all times
  • Communicate credentialing request, status and issues to the Corporate Compliance Officer as necessary
  • Complies with all health and safety regulations and requirements, departmental policies, procedures, and objectives
  • Perform other duties as new opportunities arise and/or as assigned

Knowledge, Skills & Abilities:

Education:                           

  • High School Degree or Equivalent

Experience:                          

  • Previous experience in payer relations and/or provider credentialing and communicating with key stakeholders
  • Previous experience with EchoOneApp (not required)

 Skills and Abilities:          

  • Excellent Customer Service Skills, Interpersonal and Communication skills (both oral and written); effectively communicate with a wide range of people, including executives, providers, and office staff.
  • Must have active listening skills and able to adapt to change
  • Must be a team player and effective at building and fostering teamwork as well as maintain composure when dealing with conflict.
  • The ability to manage his/her self; effectively manage resources, manages time, set priorities and work independently
  • Must be able to organize, manage multiple projects at the same time
  • Very strong knowledge and utilization in Microsoft Office, Word, Excel and all other technical or software systems Pivot utilizes.
  • Must be able to problem solve, strong sense of decision making and judgment, action oriented, approachable.
  • Ability to maintain confidentiality and uphold the principles of compliance as outlined by the company

Working Conditions:

Travel Required:  Occasionally

Hours Required:  40+ hours

 

 

Address1: 350 New Fidelity Court

Company: Pivot Physical Therapy

PostalCode: 27529

City: Garner

State: North Carolina

Community / Marketing Title: Credentialing Specialist

Company Profile:

Pivot Health Solutions is a premier provider of health and wellness services that focus on getting people back to health, preventing injury and staying fit where they work, live and play.  Our core offerings include: Pivot Physical Therapy— helping people get back on the move by delivering the highest quality care and superior functional outcomes through evidence-based practice; Pivot Occupational Health— helping businesses keep workers healthy and safe, while controlling employee health care costs; Pivot Sports Medicine— helping athletes of all ages meet their performance needs with personalized services to safely prevent or recover from sports-related injuries; and Pivot Performance— helping athletes at all levels reach peak performance with customized, instructor-led programs for individuals, semi-private groups and athletic teams. No matter where a person is on the spectrum of health, we have a personalized solution delivered by the best professionals in their chosen fields.

 

EEO Employer Verbiage:

Pivot Health Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Pivot Health Solutions complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Pivot Health Solutions expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Pivot Health Solution's employees to perform their job duties may result in discipline up to and including discharge.

Location_formattedLocationLong: Garner, North Carolina US

Pivot Health Solutions is an Equal Opportunity Employer. © 2018 All Rights Reserved.