Credentialing Specialist

Credentialing Specialist and/or
VOB/Patient Communication Coordinator

Overview

We are looking for a dynamic and motivated Credentialing/VOB Specialist. In this role, you will own the credentialing process end-to-end including tracking, file review, issue resolution, and roster auditing.
Essential functions include all aspects of medical provider credentialing, management of provider records, as well as the following:
Coordinates on-boarding process for new providers
Compiles and maintains current and accurate data for all providers for all service locations.
Completes provider payer enrollment applications; monitors applications and follows-up as needed.
Completes physician credentialing applications and obtains appropriate signatures. Handles re-credentialing as needed.
Follows all appropriate requirements set by the State of Michigan
Maintains copies of current state licenses, DEA certifications, malpractice coverage and any other required credentialing documents for all providers
Maintains knowledge of current health plan and agency requirements for credentialing providers
Sets up and maintains provider information in credentialing databases and systems.
Tracks license and certification expirations for all providers to ensure timely renewals.
Ensures practice addresses are current with health plans, agencies, and other entities.
Audits health plan directories for current and accurate provider information
Maintains confidentiality of provider information.
Provides credentialing and privileging verifications.
Monitors credentialing process and regularly follows up with third party payors.
Relays information to management and the billing department.
Builds and maintains professional relationships with third party payors.
Position may also include:
Verification of Benefits for new and current patients
Researching and resolving claim issues as related to non-payment.

WHAT YOU’LL NEED TO BE SUCCESSFUL IN THIS ROLE:
Experience:
Credentialing for providers licensed in Michigan, preferably in a behavioral health or medical office setting with the above areas of responsibilities. 2 yrs. Credentialing software experience a plus.
Experience credentialing providers with BCBSM, BCN, Aetna, Optum/United Healthcare, Medicare, HAP, Priority Health, PHP (Preferred ). 2 years
VOB with the insurance companies listed above: 2 years
Google Workspace (Preferred) or Microsoft Office: 1 year
HIPAA certification
Knowledge, Skills, and Abilities:
Skills in problem analysis and problem resolution.
Skills in computer applications.
Skills in oral communication.
Skills in planning and organizing.
Ability to communicate clearly.
Ability to multitask.
Ability to work pleasantly and efficiently with co-workers.
Ability to maintain a high level of confidentiality.
VOB/ Patient Communication Coordinator

ARE YOU THE COMPASSIONATE INSURANCE AND PATIENT COORDINATOR WITH A KNACK FOR PUZZLES THAT WE’VE BEEN SEARCHING FOR?
Do you delight in unraveling puzzles? The rewarding sensation of fitting the final pieces into their designated spaces, taking a step back to admire the finished picture – that sense of fulfillment is always worth the time spent solving the puzzle.
If you’re enthusiastic about solving puzzles and placing the last pieces in their rightful spots, we may have the ideal career opportunity for you!
If you believe you could be the missing puzzle piece in our team, then this job is tailored for YOU!

WHAT YOU’LL DO:
As the Insurance and Patient Coordinator, your responsibility is to collaborate with patients and their insurance companies to secure authorization/verification of insurance(s) and explain their benefits. Imagine the patient’s care as a giant jigsaw, and you get to play a crucial role of explaining the patient’s insurance and helping to understand their coverage and costs. Your task involves verifying insurance benefits, setting fee types and conducting daily verifications, explaining benefits to patients, managing calls from insurance/care managers, and preparing epay statements. You’ll work cooperatively with your intake and billing colleagues to ensure financial reimbursement for our patients’ services.

WHAT YOU’LL NEED TO BE SUCCESSFUL IN THIS ROLE:
Proficiency with spreadsheets
Knowledge of billing and ICD10 coding
Strong customer service skills
Ability to sit or stand for extended periods
Adaptability and able to prioritize daily what needs to be done
Ability to multitask
Great attention to detail
Insurance terminology a plus, but not required
Checks eligibility and benefits verification prior to scheduled visits.
Document updated VOB information in EHR
Contact patients regarding claims denied to determine if their insurance has changed
HIPAA certification