Essential duties and responsibilities:
- Complete and accurately submit provider payor enrollment applications, spreadsheets, and letters
- Research & keep current on payer, hospital & office based guidelines as needed to ensure processes are accurate. Review workflows to identify accuracy, efficiency and best practices.
- Follow up with payors to ensure timely enrollment and participation
- Review and follow up on weekly billing reports
- Data entry of all provider information into the Credentialing Database
- Handling incoming requests from physicians, payors, and other agencies
- Verify integrity of data
- Complete online provider CAQH re-attestations
- Assist with the development and maintenance of departmental policies and procedures
- Assist/lead new business implementations
- Oversee credentialing staff, monitor workflows, and provide support and training as required
- Assist in internal departments by resolving payment and denial issues as it relates to credentialing
- Travel between hospitals and other clinical work locations to meet with providers to obtain signatures on required documents
- Possible travel between NAPA corporate sites (Melville and Virginia)
- Facilitate and attend meetings and seminars as required
- Produce weekly and monthly productivity and issues report for management
- Other responsibilities as assigned
- Positive and professional attitude
- Ability to work with all levels of associates from entry level to upper level management
- Ability to work independently or in a group setting
- Strong knowledge of provider credentialing in a physician office, managed care or hospital setting
- Must be a self-starter and a team player who enjoys providing the highest level of customer service.
- Experience working with databases, and ability to create and manipulate excel spreadsheets
- Ability to multi-task and prioritize in a fast paced environment
- Strong communication and follow up skills
- Professional business sense and leadership skills
- Strong experience with Microsoft Office (Excel & Word specifically)
- Local & distance travel required.
Education and/or Experience
Associates Degree, Bachelor’s Degree, and/or equivalent work experience. A minimum of three years credentialing experience.