Job description

POSITION SUMMARY:

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all government and commercial payors who are contracted with FastMed Urgent Care and CareSpot | MedPost in accordance with applicable regulatory agencies, state specific requirements, company policies and management service agreements. This position will be allocated to specialists by subject matter expertise (E.g. Medicare/Medicaid vs. commercial enrollments and other government plans). Cross-training for all payors will occur throughout the duration of the specialist’s employment.

DUTIES AND RESPONSIBILITIES:

• Enrolls new providers and groups with government and commercial payors; and revalidates providers and groups with government and contracted payors

• Obtain, complete accurately, and timely submit enrollment applications and related documents

• Complete regular follow up with the payors to ensure applications are being processed

• Creates and maintains CAQH profile and ensures contracted payors receive updated information; and facilitates provider re-attestations of CAQH data as required by CAQH

• Work with revenue cycle team, credentialing team, and managed care contracting to work through denials and appeal processes

• Maintains provider payor information in online credentialing database and appropriate IT database to ensure regular and consistent communication on provider status

• Ensures practice and provider information is current with health plans, agencies, and other entities (send monthly rosters to payors)

• Audits payor directories for current and accurate provider information

• Facilitate payor calls to address contracting and credentialing issues

• Maintains confidentiality of all information; adheres to all HIPAA guidelines/regulations

• Utilize all methods available to verify status of enrollment, enrollment instructions and processes, and enrollment applications via outbound calls, web portal access, email communication

ESSENTIAL EDUCATION AND EXPERIENCE:

High School diploma or equivalent; Associate degree preferred; One (1) to Two (2) years of relevant payor enrollment experience required (either government or commercial). Knowledge of MODIO credentialing software preferred. Certified Provider Credentialing Specialist (CPCS) and/or Provider Enrollment Specialist Certificate (PESC) preferred.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• AD&D insurance
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Remote

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