Imsaz
Credentialing Specialist
Imsaz, Phoenix, Arizona, United States, 85003
Under the management, direction and leadership of the Credentialing Supervisor and CHRO, the Credentialing Specialist will be responsible for performing and maintaining timely, accurate and complete third-party payor credentialing and hospital privileging for assigned IMS providers.In this capacity, this individual ensures accurate, timely and complete submission of third-party payor credentialing/recredentialing and hospital privileging information/applications to external designees for the physicians and allied health professionals within IMS.
This individual will provide day-to-day tasks of provider status verification, external or internal correspondence, department organization, including provider files and filing, mail management, and utilizing and maintaining the credentialing database.
This individual will both proactively provide and/or timely respond to requests regarding the active credentialing and hospital privileging status of IMS providers to internal and external customers, as per the policies and procedures of the department.
This individual will consistently maintain the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and IMS's policies and procedures. Instill the IMS mission, vision and values in the work performed
ESSENTIAL FUNCTIONS
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. In conjunction with Brokers, completes activities related to malpractice insurance for all IMS providers Provide timely notifications to contracted insurance plans, including but not limited to, adding/deleting new providers, adding/deleting practice locations and any other pertinent information to be supplied to insurance plans, etc. Process timely initial and reappointments to the medical staff at hospitals, surgi-centers, etc. This includes the obtainment, organization and submission of all necessary paperwork, documents, etc. such as is needed to fulfill the requirements for hospital or free-standing facility privileging at the various organizations Gather, collate, copy and ensure filing of relevant documents needed to maintain all IMS provider files in a "current" status Submit relevant copies of documents to hospitals and insurance plans to meet requirements in keeping their IMS provider files "current" Ensure accurate and timely usage via data input of the credentialing database Work closely with the Supervisor to assure providers are added to all group contracts and that individual contracts are signed and returned in a timely manner as per the departmental process Provide assistance to specific billing department or referral/authorization staff inquiries regarding provider participation or privileging status to support timely claims processing or task completion. Provide written answers in a timely manner Follow-up on questions raised from billing or referral/authorization department personnel inquiries.Provide written answers in a timely manner Complete and submit any reporting forms as per the policies and procedures of the department, such as status grids, audits, etc. Liaison with physicians, practice managers, hospital personnel, insurance provider reps and all necessary entities to obtain necessary credentialing for IMS providers and to answer specific questions and inquiries Inform the Supervisor, CHRO or designee of any untoward provider credentialing or contracting situation such as inability to timely credential or privilege new providers (as compared to effective date with IMS); concerns or confusion regarding status, inability to gather requested documents, or other such situations that impair the timely or accurate credentialing or privileging process Inform the Supervisor, CHRO or identified designee of any untoward provider situations that might affect credentialing or privileging status immediately upon discovery (e.g. loss of privileges, malpractice, etc.) NONESSENTIAL FUNCTIONS
Actively participate in departmental meetings, payor meetings, and with departmental process and procedure development and modifications. Participate as directed in annual location site reviews Use technology to maximize process work efficiencies and effectiveness complete IMS mandatory training Participate in new department employee orientation, training and development as requested. Special projects related to credentialing and contracting as per the delegation of the Manager or Director Perform other duties as assigned Hours may vary and be outside of normal office hours depending on business needs MINIMUM JOB REQUIREMENTS
High school diploma or GED required AA degree preferred 2-4 years minimum experience required, specifically medical office and physician and hospital credentialing, 1-3 years minimum experience required, specifically medical office/physician billing and insurance claim follow-up and denial management Knowledge of health plan websites, CAQH, Intelli App software program, licensing boards, NPPS (NPI) Medicare (PECOS), National Provider DB and hospital CVO's required Excellent oral and written communication skills Strong interpersonal skills, Ability to get along well with others; team player Demonstrated ability to maintain confidentiality Strong organizational skills; Able to handle a variety of tasks and prioritize Goal orientation; excellent follow-through Self motivated; self-starter Detail oriented Pro-active Demonstrates willingness to accept responsibility and accountability for assigned tasks The ability to work in a constant state of alertness and in a safe manner
Joining Integrated Medical Services is more than saying "yes" to making the world a healthier place.It's discovering a career tat's challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individuals expression in the workplace and thrive on the innovative ideas this generates.Our hop is that each day you'll uncover a new reason to love what you do.If this sounds like the workplace for you, apply now!
You can look forward to a generous compensation package including medical dental, vision, short-term and long-term disability, life insurance, paid time off ana very lucrative 401k plan.
**IMS is a tobacco-free work environment
IMS is an equal employment opportunity employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity age, protected veteran status or any other characteristic protected by law.Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
This individual will provide day-to-day tasks of provider status verification, external or internal correspondence, department organization, including provider files and filing, mail management, and utilizing and maintaining the credentialing database.
This individual will both proactively provide and/or timely respond to requests regarding the active credentialing and hospital privileging status of IMS providers to internal and external customers, as per the policies and procedures of the department.
This individual will consistently maintain the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and IMS's policies and procedures. Instill the IMS mission, vision and values in the work performed
ESSENTIAL FUNCTIONS
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. In conjunction with Brokers, completes activities related to malpractice insurance for all IMS providers Provide timely notifications to contracted insurance plans, including but not limited to, adding/deleting new providers, adding/deleting practice locations and any other pertinent information to be supplied to insurance plans, etc. Process timely initial and reappointments to the medical staff at hospitals, surgi-centers, etc. This includes the obtainment, organization and submission of all necessary paperwork, documents, etc. such as is needed to fulfill the requirements for hospital or free-standing facility privileging at the various organizations Gather, collate, copy and ensure filing of relevant documents needed to maintain all IMS provider files in a "current" status Submit relevant copies of documents to hospitals and insurance plans to meet requirements in keeping their IMS provider files "current" Ensure accurate and timely usage via data input of the credentialing database Work closely with the Supervisor to assure providers are added to all group contracts and that individual contracts are signed and returned in a timely manner as per the departmental process Provide assistance to specific billing department or referral/authorization staff inquiries regarding provider participation or privileging status to support timely claims processing or task completion. Provide written answers in a timely manner Follow-up on questions raised from billing or referral/authorization department personnel inquiries.Provide written answers in a timely manner Complete and submit any reporting forms as per the policies and procedures of the department, such as status grids, audits, etc. Liaison with physicians, practice managers, hospital personnel, insurance provider reps and all necessary entities to obtain necessary credentialing for IMS providers and to answer specific questions and inquiries Inform the Supervisor, CHRO or designee of any untoward provider credentialing or contracting situation such as inability to timely credential or privilege new providers (as compared to effective date with IMS); concerns or confusion regarding status, inability to gather requested documents, or other such situations that impair the timely or accurate credentialing or privileging process Inform the Supervisor, CHRO or identified designee of any untoward provider situations that might affect credentialing or privileging status immediately upon discovery (e.g. loss of privileges, malpractice, etc.) NONESSENTIAL FUNCTIONS
Actively participate in departmental meetings, payor meetings, and with departmental process and procedure development and modifications. Participate as directed in annual location site reviews Use technology to maximize process work efficiencies and effectiveness complete IMS mandatory training Participate in new department employee orientation, training and development as requested. Special projects related to credentialing and contracting as per the delegation of the Manager or Director Perform other duties as assigned Hours may vary and be outside of normal office hours depending on business needs MINIMUM JOB REQUIREMENTS
High school diploma or GED required AA degree preferred 2-4 years minimum experience required, specifically medical office and physician and hospital credentialing, 1-3 years minimum experience required, specifically medical office/physician billing and insurance claim follow-up and denial management Knowledge of health plan websites, CAQH, Intelli App software program, licensing boards, NPPS (NPI) Medicare (PECOS), National Provider DB and hospital CVO's required Excellent oral and written communication skills Strong interpersonal skills, Ability to get along well with others; team player Demonstrated ability to maintain confidentiality Strong organizational skills; Able to handle a variety of tasks and prioritize Goal orientation; excellent follow-through Self motivated; self-starter Detail oriented Pro-active Demonstrates willingness to accept responsibility and accountability for assigned tasks The ability to work in a constant state of alertness and in a safe manner
Joining Integrated Medical Services is more than saying "yes" to making the world a healthier place.It's discovering a career tat's challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individuals expression in the workplace and thrive on the innovative ideas this generates.Our hop is that each day you'll uncover a new reason to love what you do.If this sounds like the workplace for you, apply now!
You can look forward to a generous compensation package including medical dental, vision, short-term and long-term disability, life insurance, paid time off ana very lucrative 401k plan.
**IMS is a tobacco-free work environment
IMS is an equal employment opportunity employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity age, protected veteran status or any other characteristic protected by law.Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.