The Prelude Network Houston , TX 77020
Posted 6 days ago
Inception Fertility is a family of patient-centered, tech-enabled brands that together seek to redefine the fertility patient experience. We believe every great patient experience starts with a great employee experience and strive to provide our staff with everything they need to consistently deliver safe, efficient, and compassionate patient care.
We are looking to hire an organized and motivated Credentialing Specialist to assist us with tasks and related projects pertaining to our Physician and practitioners' credentialing and third-party payor contracting. The Credentialing Specialist will build, organize, verify and maintain up-to-date files on all Physicians and practitioners. This includes tracking the expiration of certifications and CAQH profiles.
ESSENTIAL RESPONSIBILITIES:
Ensure protocols are being followed to guarantee timely resolution and completion of payor enrollment in order to prevent loss of revenue due to untimely payor enrollment.
Accurately prepare all required paperwork for provider payor enrollment/re-enrollment.
Accurately document tasks in the departmental tracking system
Audit all paperwork before submitting to ensure the paperwork is completed and the data is accurate.
Provide weekly status reports of open items/projects to management.
Responsible for communicating any potential issues with providers who have not completed required paperwork.
Ensure quantity and quality of work meets departmental productivity/quality standards.
Process initial credentialing and re-credentialing applications
Audit practitioners' applications and supporting documentation
Identify discrepancies in information and conduct follow-ups
Assist third party payors with credentialing inquiries
Respond to provider and practice management inquiries
Ensure data is complete accurate in credentialing database and other internal sources
Must be able to multi-task and work both independently and as part of a team; and able to successfully work with practices in multiple states
Assists with special projects as needed.
Other duties as assigned.
KNOWLEDGE AND SKILLS:
High school diploma or GED required; Associates degree or equivalent experience preferred
3+ years credentialing experience in a managed care or hospital setting highly preferred
Excellent verbal and written communication skills
Experience with credentialing databases preferred
Demonstrated knowledge of third-party and insurance company operating procedures, regulations and billing requirements
Previous experience with privilege requests for physicians for hospitals and other healthcare facilities required
Working knowledge of payor credentialing rules and regulations
Experience working with Council for Affordable Quality Healthcare, Inc (CAQH)
Inception offers fantastic benefits to our team (Family members):
FREE employee only coverage option for the medical, dental and vision plans plus FREE basic life insurance, EAP and long-term disability insurance!
Adoption assistance and fertility benefits
Maternity and paternity/partner paid leave
401k with generous match
11 Company-paid holidays (1 floating holiday)
PTO starting at 18 days/year
Family member recognition program
Professional, collaborative, team-centered work environment
Continuing education/professional development reimbursement and time off
Family member referral program
The Prelude Network