Credentialing Coordinator I Job at Athletico
Overview:
Position Summary: Reviews applications, prepares verification letters, and contacts clinical staff and insurance carriers to ensure that all active therapists have completed applications and credentialing/re-credentialing information on file with applicable contracted payers. Responsibilities:
Physical Demands:
Work Environment:
Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Greater Purpose and Core Values: Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.
Position Summary: Reviews applications, prepares verification letters, and contacts clinical staff and insurance carriers to ensure that all active therapists have completed applications and credentialing/re-credentialing information on file with applicable contracted payers.
Essential Duties and Responsibilities:
The below is not an exhaustive list of duties and you will be expected to perform different tasks as necessitated by your changing role within the organization and the overall business objectives of the organization.
- Obtains all necessary credentialing information and documentation required for payer enrollment process and verifies complete standard applications for new hires
- Facilitates the credentialing process of new hires to ensure accurate and timely submission of enrollment applications
- Tracks and reports progress in credentialing database, performs follow up activities as needed until enrollment profile is completed
- Monitors payer portals to ensure revalidations and re-enrollments are submitted timely
- Completes all re-credentialing and revalidation of commercial and government requests for individual providers and service locations
- Maintains provider and facility files current and up-to-date with enrollment submissions and all payer correspondence
- Ensures the timely submission and monitors completion of new hire PSV initial and re-credentialing events
- Follows up with payers on outstanding credentialing issues in a timely and consistent manner
- Responds in a timely manner to emails related to payer enrollment
- Participates in payer enrollment projects and initiatives
- Notifies payers of professional and clinical staff updates such as service locations, periodic roster updates, name changes, official notices, etc., on an ongoing basis
- Audits provider rosters upon payer requests
Qualifications:
- Education:
- High school diploma or equivalent required
- Work Experience:
- Minimum 1 year of payer enrollment experience required; 2-3 years' experience preferred
- Certification/Licensure:
- Preferred, but not required
- Knowledge and Technical Skills:
- Proficient in Microsoft Office (Word, Excel, PowerPoint) required
- Knowledge of CAQH/Proview, NPPES/I&A Management System and PECOS required
- Knowledge of Medicare’s enrollment process, including enrollment forms required
- Detail-oriented and excellent organizational skills
Language Skills:
- Ability to read, write and speak English proficiently
The physical demands and work environment describe here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
Physical Demands:
- Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e. while working at a desk), stoop/kneel/crouch, travel around the office, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding.
- Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
Work Environment:
- Consistent with a standard office environment, noise level is low with little to no extraordinary environmental factors.
Athletico provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
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