Insurance Credentialing Specialist
Company: Pediatric Dental Center Of Gardens
Location: Miami
Posted on: January 27, 2023
Job Description:
Job DescriptionPosition SummaryThe Insurance Credentialing
Associate is responsible for maintaining active status for all
providers by successfully completing initial and subsequent
insurance credentialing as required by commercial payers, Private
Insurances and Medicaid, per general guidelines, ensuring
compliance with internal policies and external regulatory
agencies.Education/Experience
- High school diploma or equivalent required
- One (1) year related experience (insurance credentialing,
insurance billing, mental health/behavioral health setting, and/or
medical office setting) required
- Electronic Health Record (EHR) experience helpful
- Must demonstrate the ability to work in Google Apps (Gmail,
Docs, Sheets, Slides)
- Knowledge of Medicaid, Medicare, etc. highly preferredDuties
Include:
- Major Duties and Responsibilities:
- Initiate and maintain credentialing for all locations
- Communicate adverse, incomplete, or questionable data to
designees and recommend appropriate course of action.
- Initiate and maintain payor enrollment.
- Prepare initial credentialing and re-credentialing files to be
presented to the C.O.O in a timely and expeditious manner
- Initiate and maintain provider services payor enrollment as
assigned
- Ensure accuracy and completeness of provider services
applications whether state or private
- Provide regular updates to the payors of changes in billable
provider demographics, practice locations, name changes, etc.
- Maintain accurate and concurrent updates for each location to
reflect the history of a organization's credentialing and
enrollment status
- Resolve complex issues relating to provider credentialing
- Respond to requests by external and internal entities regarding
issues pertaining to the status of credentialing and/or enrollment
of organization.
- Prepare for re-credentialing applications on all services and
locations
- Other duties upon request
- KNOWLEDGE, SKILLS AND ABILITIES
- Comprehensive knowledge of medical, clinical, and payor (both
commercial and managed care) credentialing regulations and
process
- Strong organizational skills, detail-orientation with the
ability to prioritize
- Time management skills in a fast-paced environment
- Excellent Analytical skills to problem solving
- Strong communication both written and verbal
- Problem solving skills and ability to explore all options and
use available resources to find new and effective solutions
- Strong organizational, critical thinking and problem-solving
skills required
- Ability to communicate appropriately and effectively with
providers; including sensitive and confidential information
- Must be able to prioritize and meet deadlines on an ongoing
basis to ensure timely completion according to process
requirements
- Exhibits sound judgment and one who hold themselves up as a
role model and mentorInsurance Credentialing Specialistby
Jobble
Keywords: Pediatric Dental Center Of Gardens, Miami , Insurance Credentialing Specialist, Other , Miami, Florida
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