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Credentialing Coordinator

Company: CDR Maguire
Location: Augusta
Posted on: January 27, 2023

Job Description:

JOB SUMMARY:

At the highest level, must "Show Up" enthusiastic, entrepreneurial "Figure it Out", and committed to "Getting it Done" to performing their job in an ethical and proper manner while the team "Wins Together". This role will track the expiration of certifications to maintain up to date files and assist health plan providers and customers with phone inquiries.

ESSENTIAL FUNCTIONS:

  • Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
  • Maintain internal provider grid to ensure all information is accurate and logins are available.
  • Ability to overcome any obstacles from insurance payer rejections, whether that by phone or in person
  • Update each provider's CAQH database file timely and according to the schedule published by CMS.
  • Apply for and renew annually all provider licenses (Professional, DEA, Controlled Substances).
  • Complete revalidation requests issued by government payers.
  • Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
  • Complete re-credentialing applications for commercial payers.
  • Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
  • Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
    Requirements

    EDUCATION, EXPERIENCE AND SPECIAL SKILLS REQUIRED:
    • High school diploma or equivalent preferred
    • Medical billing and coding experience highly preferred
    • Ability to communicate clearly, work effectively as a team member with physicians and other staff
    • Sort and file materials correctly by alphabetical or numeric systems
    • Interpret and understand insurance benefits and reimbursements
    • Flexibly respond to changing demands
    • Organize and prioritize tasks effectively
    • Work with little supervision
    • Establish and maintain effective working relationships with patients, employees, and the public

      CDR Maguire is an Equal Opportunity Employer M/F/D/V and EO/AAN/D. Must be able to work in the United States to apply.

Keywords: CDR Maguire, Augusta , Credentialing Coordinator, Other , Augusta, Georgia

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