Credentialing Specialist

Credentialing Specialist – Trumbull Regional Medical Center/Hillside Rehabilitation Hospital

We are fighting for a healthier world and a new era of wellness!

At Trumbull Regional Medical Center, we are committed to improving the health of our communities by delivering exceptional, personalized behavioral health care with dignity, compassion and respect. Our continued focus on the patient experience informs our caregivers in how to provide care that is respectful of and responsive to individual patient and family preferences, needs and values.

Summary:

Under the direction of the Director of Medical Staff Services/Medical Staff Office, the Credentialing Specialist will be responsible for provider enrollments with various insurance companies. Responsible to the customer for courteous, accurate, timely service.

Salary Range: $20.00– 25.00

Hybrid w/potential remote

Benefits:

• Grow with a health system that supports career advancement
• Competitive Pay & Salary Increases
• Employee Referral Program
• Locations close to home, that support work-life balance
• Affordable Medical, Dental and Vision Coverage
• 401k via Empower, for eligible employees, with company match
• Tuition Assistance / Reimbursement
• Family atmosphere and team approach that provides flexibility
• Opportunities to grow your career, and not change your employer
• And much more!

REQUIREMENTS:

• High school diploma required. BA preferred. Must be familiar with Ohio enrollments/payers.
• Three (3) to /five (5) years’ experience in credentialing is required.
• Experience in Physician/Advanced Practice Payer enrollment, preferably in a hospital environment.

RESPONSIBILITIES AND MAJOR DUTIES

• Efficiently complete/maintain provider/practice enrollments, revalidations, and any demographic change with contracted and government payers for the reimbursement of services.
• Problem-solve enrollment issues with practices, providers, payors and revenue cycle areas.
• Verify and identify errors with NPI (National Provider Information) numbers for new practices/provides based on taxonomies.
• Work closely with team members to ensure tasks are completed and understood so we all know the flow.
• Submit new providers and terms or updates via rosters internally as well as to each payor per requirements on a monthly to bi-monthly basis or as needed.
• Prepare and submit accurate applications for new practices/providers and processes updates and changes.
• Addresses concerns and patterns that arise in issues with enrollment and credentialing based on payor guidelines and feedback.
• Assist in staff with CAQH and provider enrollment information that is needed to help avoid unnecessary rejections and delays.
• Obtain manager access from providers via email to Pecos and Impact as needed in-process tasks within the specified systems and time frames.
• Attend virtual company, payor meetings.
• Facilitate revalidation/termination applications needed for all providers/practices following the payer requirements.
• Work with supervisors/billers on denials referencing enrollment issues.
• Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanning of the hard copy documents and document each stage of enrollment/re-enrollment process.
• Ongoing training to remain current on enrollment requirements, not limited to Payor website news, reviews, meetings and webinars.
• Works collaboratively with fellow team members to create, evaluate and maintain department workflows, processes, policies and systems.
• Provide additional status reports and updates as needed.
• Follows and maintains all confidential requirements with provider data.
• Other duties as assigned.

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work assignments that may be inherent in the job.

Trumbull Regional Medical Center is an Equal Employment Opportunity (EEO) employer. Trumbull Regional Medical Center does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.

For more information, visit trumbullregional.org