Credentialing Specialist
Job Description
Job Description
Credentialing Specialist
Description: The Credentialing Specialist provides financial, administrative, and clerical support to Credentialing areas of Tryon Management Group. This includes quarterly attestations and payer enrollment functions.
(This is a full-time position based out of the MSO in SouthPark, Monday to Friday 8 am to 5 pm). Responsibilities:- Monitors tasks within credentialing platform to mitigate any delays and ensure completion from internal stakeholders.
- Actively reviews and resolves Enrollment dashboard issues within EMR system.
- Alerts management to unfavorable patterns/trends.
- Verify participation of all line of business with a payer.
- Contact payer(s) on claims when an enrollment issue exists.
- Acts as a point of contact for assigned department(s) for incoming questions regarding third-party billing requirements because of payer enrollment.
- Analyzes trends in under/overpayments and payment denials and works collaboratively.
- Keep provider enrollment tables up to date with effective participation/term dates, taxonomy codes, NPI within EHT platform.
- Completes all internal On/Offboarding tasks for all clinicians.
- Updates fee schedule in Practice Management system as needed.
- Maintains allowable schedules in the Practice Management system, as needed.
- Other duties as assigned.
Requirements:
- High school diploma or GED required.
- High level of proficiency in Microsoft Excel.
- Ability to work autonomously and as a member of a team, team player with a positive attitude.
Experience:
- 5+ years in a healthcare related industry
- All aspects of Payer Credentialing
- Front office operations
- Payer follow-up and collections
Physical Requirements:
- Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
- Must be able to lift and support weight of 35 pounds.
- Ability to concentrate on details.
- Use of computer for long periods of time.
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