Credentialing Specialist

Employer
Red Rock Behavioral Health Services
Location
Oklahoma City, OK
Posted
Mar 24, 2017
Jobs Outside Higher Education
Businesses & Consultants
Institution Type
Outside Academe


Job Description

SUMMARY

Ensures continued credentialing of all eligible providers, solicits new insurance panels; investigates potential insurance panels, and utilizes the OHCA website and Red Rock website to check consumer eligibility.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
  • Understands professional telephone etiquette
  • Demonstrates ability to work with minimal supervision and works well in both individual and group environment.
  • Provides support to executive management and the operations department in relations to credentialing.
  • Maintains high quality, timely and accurate credentialing processes of healthcare providers per HPP policy and procedure.
  • Assists in the credentialing process by entering/logging/scanning information into the credentialing system for initial, updating, and add on applications and maintenance process.
  • Acts as liaison with MSO as point person for completing and ensuring compliance and delivery of required information to providers in a timely manner.
  • Processes and maintains credentialing and re-credentialing in accordance with client facility policy and procedure, Joint Commission standards, State and Federal Regulatory regulations. This includes, but is not limited to, the following verifications:
    • National Practitioner Data Bank
    • DEA Verification Licensure
    • Board Certification Training verified; Residency/Fellowship training verified
    • Peer Recommendation; Professional Education verified
  • Monitors collection of all information received; follows up on missing items and/or incomplete forms, submits follow up requests for verifications as needed.
  • Identifies and evaluates potential red flags and works in collaboration with practitioner to document the issue and healthcare provider response
  • Advises Business Office Manager of questionable information received and any issues identified during the processes.
  • Maintains all credentialing files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; keeps current process and legal/regulatory requirements.
  • Assists with financial, clerical and administrative services to ensure efficient, timely and accurate consumer billing and follow up in accordance with Red Rock BHS protocol.
  • Verifies eligibility of benefits with the OHCA, private insurance companies and other contractors.
  • Sets up and maintains all payor sources for consumers
  • Performs other duties and works on special projects as requested.



QUALIFICATIONS
  • High School Diploma or equivalent
  • Minimum one-year experience preferred in healthcare credentialing (i.e., healthcare facility, managed care facility, credentials verification organization, or Medical Staff Office).
  • Minimum one-year experience verifying Commercial insurance benefits.
  • Experience with Credentialing Accreditation by Joint Commission or National Committee for Quality Assurance preferred.
  • Strong problem solving skills, good judgment, attention to detail and follow-through.
  • Experience working with the Oklahoma Health Care Authority is a plus.
  • Ability to maintain confidentiality of privileged information grained.
  • Ability to work independently, productively and well under pressure.
  • Preferred Associate's Degree
  • Preferred three years' experience in A/R, billing and cash collections.
  • Preferred demonstrated working knowledge of the healthcare and credentialing industry, including medical-legal issues and laws, regulatory agencies, and other national standards.
  • Commitment to the mission of Red Rock BHS.

Company Description
Red Rock Behavioral Health Services is a not-for-profit comprehensive behavioral health service provider established in 1974. We positively change the lives of youth and adults by providing and coordinating their behavioral and physical health in an effort to strengthen families and support the community. We offer a full benefit package to all full time employees to include 100% employer paid medical insurance for the employee, a generous paid time off plan, and a retirement plan. Red Rock BHS does offer many other benefits. To learn more about Red Rock, visit www.red-rock.com.


Oklahoma City, OK

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Thu, 23 Mar 2017 08:20:28 PDT

PI97272720