Credentialing Specialist (WFH)

Job Summary

We are seeking a dedicated Credentialing Specialist to join our team. In this position, you are responsible for the complete credentialing process as defined by payer credentialing policies and procedures including provider manuals, contract language and requirements to ensure Rotech compliance and contract performance standards are met for all Rotech Locations.

Position responsibilities also include, re-credentialing, submission of COIs and licensure expirations, LANs, provider acquisition reporting and ensuring Rotech’s compliancy with the No Surprise Act.

Work From Home after successful completion of IN OFFICE TRAINING and are meeting expectations with management approval

Essential Job Duties and Responsibilities

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.

Duties, responsibilities and activities may change at any time with or without notice.)

• Administration of contracts includes but not limited to a complete review of payer contract language, policies and procedures, provider manuals, billing rules and guidelines
• Analyzes monthly trend reports (Held Item, Adjustment Analysis) to identify additional research and / or updates required to Contract / Item Master
• Assigns and updates necessary contract classifications for Managed Care / Government Reporting purposes
• Assist with projects at BCC when access to older billing rules, HCPCs, ICD9, etc. is required to process claims in arrears (monitor window of claims processing to ensure no inaccurate billing occurs during project time frame)
• Assists in creating and maintaining Rotech’s Supplier Diversity Database including yearly mailing to all Rotech vendors
• Communicates with Purchasing on appropriate base contract pricing- Contract
• Communicates with the Billing Center, Central Intake, Sleep Central and Locations regarding contract changes and / or updates including distribution of reference guides as required
• Completes payer credentialing and re-credentialing applications via hard copy, email, fax or online based on payer specifications
• Conducts conference calls with payors as required
• Conducts Contact implementations with appropriate departments as well as payer in-services as required
• Conducts / leads calls with payers regarding changes and / or updates to payer rules, processes, guidelines, pricing methodologies and credentialing practices
• Creates and maintains job aids and training materials as it relates to contract and credentialing functions and systems used within CAD
• Creates FOIA requests as appropriate
• Files yearly government reports such as Subcontracting report, CCR registration, Vets-100
• Maintains Contract Quick Reference Guides on the Rotech Home Page
• Maintains current Location database spreadsheet and COIs
• Maintains database of contracts within shared drive, e-Intake and Contract Logix
• Maintains database of credentialing / re-credentialing within Laser Fiche and shared drive
• Maintains Location Dashboard information so assigned contracts appear on appropriately contracted locations
• Maintains monthly LANs updates and appropriate payer notification
• Maintains pricing and other updates within the online ordering system as required
• Maintains timely filing requirements outlined in Contracts to ensure claims drop as required by Contracted Payers into the timely filing cue within the billing center
• Maintenance and administration of all Contracts Rotech provides service for including but not limited to Managed Care, Government, Hospice, Skilled Nursing, Non-Participating or Out of Network, Professional Service Agreements and Patient Pay Contracts
• Monitors the release of solicitations daily and maintains a list of active solicitations within company database
• Obtains and updates all Medicare and Medicare Non-Assigned Contracts as new HCPCS, Pricing, Modifiers, Certification requirements are published and available (researching websites, payor payment boards, government websites, etc.)
• Obtains, researches, and updates each State’s Medicaid Contract, HCPCS, Pricing, Modifiers and Certification requirements as published on various state websites, government payment boards, etc.
• Performs maintenance and administration of HCPCS and ICD-9 codes as updated, changed or published by Medicare to ensure appropriate HCPCS and ICD9 are available for predetermined effective date and claims processing
• Receives, researches, and validates payer claims addresses and designates applicable billing requirements that will print on all Rotech paper claim forms.

Maintains all updates or changes to these requirements as submitted by locations, BCC’s, and / or payers

• Research and applies internal company rules and policies to all items set-up on contracts, Sales Commission Points, Assignment of Benefits Requirements, Coverage type for Rent to Cap items, product category, product class inventory track able items, eintake viewable items, eintake product kit set ups and manufacturer requirements
• Research of competitor information
• Researches and verifies contract requirements through various sources (billing / payment history, payor provider support, etc.

when there are no contracted requirements on file

• Updates all Private Insurance Contracts that are on schedule with Medicare HCPCS, Pricing, Modifier and Certification updates (as provided on payor profile, through contracting department, or payor payment boards / websites, etc.)
• Performs other duties as assigned

Qualifications

Employment is contingent on

• Background investigation (company-wide)
• Drug screen (when applicable for the position)
• Valid driver’s license in state of residence with a clean driving record (when applicable for the position)

Required Education and / or Experience

• High school diploma or GED equivalent, required
• Knowledge of Healthcare Contract Language and the ability to read and interpret Contract / Credentialing requirements and guidelines
• Five years directly related experience in the medical industry working with HCPCS, CPT and ICD-9 Codes

Preferred Education and / or Experience

• Paralegal Certificate, preferred
• Bachelor’s Degree or equivalent combination of college education and / or related work experience in healthcare, billing, and / or industry contracts, preferred
• Lead / Supervisory experience

Skills and Competencies

• Ability to identify and resolve potential financial risk items / situations
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
• Ability to think critically and analytically
• Effectively communicate in English; both oral and written
• Interpret a variety of communications (verbal, non-verbal, written, listening and visual)
• Knowledge of Industry Contracts and medical billing
• Maintain confidentiality, discretion and caution when handling sensitive information
• Multi-task along with attention to detail
• Self-motivation, organized, time-management and deductive problem solving skills
• Work independently and as part of a team

Machines, Equipment and Technical Abilities

• Email transmission and communication
• Internet navigation and research
• Microsoft applications; Outlook, Word and Excel
• Innovative Medical Billing System (IMBS) preferred
• Office equipment; fax machine, copier, printer, phone and computer and / or tablet

Physical Demands

• Lift and carry office equipment at times
• Requires sitting, walking, standing, talking and listening
• Requires close vision to small print on computer and / or tablet and paperwork

Rotech Information

Benefits

• 401k
• Medical, Dental and Vision
• Life Insurance and Disability
• Generous Paid Time Off and Paid Holidays
• Employee Discount Program
• Employee Recognition Program
• Bonus and Incentive Opportunities
• Mileage reimbursement (when applicable for the position)
• Telephone reimbursement (when applicable for the position)
10 days ago