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Credentialing Specialist

Company: Halifax Hospital Medical Center
Location: Daytona Beach
Posted on: September 20, 2022

Job Description:

OverviewHalifax Health is seeking a Credentialing Specialist for the Credentialing Services Department.SummaryThe Credentialing Specialist participates as an active component of the Revenue Cycle by coordinating Hospital and Physician Group provider credentialing and enrollment activities with all governmental and Managed Care payors. Dialogs with hospital service line administrators, - managers, providers, agencies and health plans to ensure prompt completion of the credentialing process to ensure claim payment. -This individual must be able to function well and meet deadlines under stressful conditions, must be flexible and able to continually reorganize work to adapt to changing circumstances, able and willing to work with the Managed Care Coordinator or Designee in suggesting department workflows and resolutions. They must be able to manage a demanding work load as well as be flexible with regards to work hours, work well with others, willing to embrace a team environment, and have the ability to multi-task. Must have reliable transportation and be available to use it to pick up and deliver credentialing documents as needed.Job Qualifications

  • Associate's degree or equivalent work experience. -
  • 2-5 years in a hospital Medical Staff Office or Physician group practice preferred.
  • NAMSS certification preferred but not required.
  • Excellent oral and written communication skills
  • Ability to maintain multiple projects simultaneously
  • Strong organizational skills
  • Experience with computers, database and word processing essential.
  • Previous experience in Managed Care credentialing and/or provider enrollments in governmental agencies.
  • Ability to work professionally and effectively with Physicians, Office Managers, Hospital Management staff and Managed Care organizations.
  • Must be flexible and a strong team player. Expected to assist other Team Members as needed.
  • Must be a Florida Notary or earn Notary within 6 months of employment.Job Duties and Responsibilities
    • Accurately populate the Credentialing database with detailed provider information related to credentials and enrollments.
    • Document effective dates, expiration of licensure, DEA, provider numbers, etc. used in the billing process. Maintain provider file to include original documents.
    • Retrieve documents as needed to maintain current provider credentials for distribution to credentialing agencies. Responsible for requesting updated documents from provider, management, or provider designee.
    • Determine enrollment and credentialing needs for new providers, compile necessary documentation and submit for enrollments with Medicare, Medicaid, Tricare and others. - Provide notice to contracted plans for initiation and completion of provider credentialing.
    • Provide routine follow up on submitted documents to ensure timely enrollment/credentialing completion.
    • Initiate notice to Physician Services or other billing services requiring information on new and leaving providers, par effective dates, provider numbers used in billing - and other information necessary to the Revenue Cycle.
    • Provide support to providers and management staff - as it relates to provider enrollment and credentialing via telephone, email or in person. Assists in investigation and resolution of claims issues attributed to enrollment.
    • Prepare necessary reports for management staff for enrollment status, provider rosters for managed care and others as may be needed.
    • Prepare necessary reports for management staff for enrollment status, provider rosters for managed care and others as may be needed.
    • Meet with physicians, office management staff - and Medical Staff office to retrieve documentation, secure approval of documents and signatures necessary for enrollments/ credentialing.
    • Maintain high quality, positive relationships with physicians, Halifax managers, office management staff, and external enrollment/ credentialing contacts.
    • Provide feedback to necessary PBFS staff as may be relayed by a contact for follow up as needed.
    • Provide credentialing services as needed for maintenance of physician and hospital managed care contracts and re-credentialing. -
    • Secure and maintain a Florida State Notary certification.
    • Other duties as assigned.About UsRecognized as one of the 50 Top Cardiovascular Hospitals in the United States by IBM Watson Health, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the areas largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in womens health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization. Halifax Health offers the areas only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks. For more information, visit halifaxhealth.org.

Keywords: Halifax Hospital Medical Center, Daytona Beach , Credentialing Specialist, Other , Daytona Beach, Florida

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