OUR COMPANY: WE ARE A LARGE MULTI-REGIONAL DERMATOLOGY PRACTICE BASED IN NY AND NJ, WE SPECIALIZE IN MEDICAL, SURGICAL AND COSMETIC DERMATOLOGICAL CARE. WE HAVE OVER 30 PROVIDERS OVER 15+ LOCATIONS AND CONTINUE TO GROW. JOIN OUR TEAM!
Responsibilities
Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, local and University regulations, guidelines, policies, and standards.
Conducts primary source verification, collects and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to credentialing standards and UNM Health System criteria.
Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to CVO Credentialing Manager and entity Medical Staff Affairs for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
Communicates clearly with providers, their liaisons, entity Medical Staff Affairs. medical staff leadership and Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
Performs miscellaneous job-related duties as assigned.
EDUCATION, EXPERIENCE, TRAINING
Familiarity with eClinicalWorks and Dermatology Practice strongly preferred
Previous experience with in and out of network insurance contracts
Strong understanding of carrier fee schedules, and allowed amount for clear claim adjudication and processing.
Knowledge of HIPAA, ICD-10 and CPT coding
Requires strong multitasking abilities, communication, and organizational skills.
Ability to perform routine mathematical calculations, high usage of numeric keypad and 12 calculator
Proficient Microsoft Suite User, Google Drive, Skilled in Microsoft Excel, Type 40+ WPM
Job Type: Full-time
Schedule:
Application Question(s):
- What is your desired compensation?
- Can you train in Elizabeth, NJ?
- Are you able to work hybrid in office 2 days a week?
Experience:
- Medical Credentialing: 2 years (Required)
Work Location: In person