Credentialing Specialist

About Rotech Join a Leader in Home Healthcare At Rotech Healthcare Inc., we're more than a medical equipment provider-we're a trusted partner in patient care. As a national leader in ventilators, oxygen therapy, sleep apnea treatment, wound care, diabetic solutions, and other home medical equipment, we empower patients to manage their health from the comfort of home. With hundreds of locations across 45 states, our team delivers high-quality products, exceptional service, and compassionate support that helps patients live more comfortably, independently, and actively. Whether you're a clinician, technician, or healthcare administrator, your work at Rotech directly improves lives. Explore more about our mission and services at Rotech.com. Overview and Responsibilities Job SummaryWe 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 guidelinesAnalyzes monthly trend reports (Held Item, Adjustment Analysis) to identify additional research and/or updates required to Contract/ Item MasterAssigns and updates necessary contract classifications for Managed Care/Government Reporting purposesAssist 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 vendorsCommunicates with Purchasing on appropriate base contract pricing- ContractCommunicates with the Billing Center, Central Intake, Sleep Central and Locations regarding contract changes and/or updates including distribution of reference guides as requiredCompletes payer credentialing and re-credentialing applications via hard copy, email, fax or online based on payer specificationsConducts conference calls with payors as requiredConducts Contact implementations with appropriate departments as well as payer in-services as requiredConducts/leads calls with payers regarding changes and/or updates to payer rules, processes, guidelines, pricing methodologies and credentialing practicesCreates and maintains job aids and training materials as it relates to contract and credentialing functions and systems used within CADCreates FOIA requests as appropriateFiles yearly government reports such as Subcontracting report, CCR registration, Vets-100Maintains Contract Quick Reference Guides on the Rotech Home PageMaintains current Location database spreadsheet and COIsMaintains database of contracts within shared drive, e-Intake and Contract LogixMaintains database of credentialing/re-credentialing within Laser Fiche and shared driveMaintains Location Dashboard information so assigned contracts appear on appropriately contracted locationsMaintains monthly LANs updates and appropriate payer notificationMaintains pricing and other updates within the online ordering system as requiredMaintains timely filing requirements outlined in Contracts to ensure claims drop as required by Contracted Payers into the timely filing cue within the billing centerMaintenance 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 ContractsMonitors the release of solicitations daily and maintains a list of active solicitations within company databaseObtains 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 processingReceives, 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 payersResearch 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 requirementsResearch of competitor informationResearches and verifies contract requirements through various sources (billing/payment history, payor provider support, etc.) when there are no contracted requirements on fileUpdates 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 onBackground check (company-wide). Results will not be used automatically to disqualify individuals. Instead, the Company will conduct an individualized assessment that considers the duties of the position, the nature and timing of the offense, and any evidence of rehabilitation, in accordance with applicable laws.Drug screen (when applicable for the position)Compliance with healthcare facility credentialing process (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 ExperienceHigh school diploma or GED equivalent, requiredKnowledge of Healthcare Contract Language and the ability to read and interpret Contract/Credentialing requirements and guidelinesFive years directly related experience in the medical industry working with HCPCS, CPT and ICD-9 CodesPreferred Education and/or ExperienceParalegal Certificate, preferredBachelor's Degree or equivalent combination of college education and/or related work experience in healthcare, billing, and/or industry contracts, preferredLead/Supervisory experienceSkills and CompetenciesAbility to identify and resolve potential financial risk items/situationsAbility to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization existsAbility to think critically and analyticallyEffectively communicate in English; both oral and writtenInterpret a variety of communications (verbal, non-verbal, written, listening and visual)Knowledge of Industry Contracts and medical billingMaintain confidentiality, discretion and caution when handling sensitive informationMulti-task along with attention to detailSelf-motivation, organized, time-management and deductive problem solving skillsWork independently and as part of a teamMachines, Equipment and Technical AbilitiesEmail transmission and communicationInternet navigation and researchMicrosoft applications; Outlook, Word and ExcelInnovative Medical Billing System (IMBS) preferredOffice equipment; fax machine, copier, printer, phone and computer and/or tabletPhysical DemandsLift and carry office equipment at timesRequires sitting, walking, standing, talking and listeningRequires close vision to small print on computer and/or tablet and paperwork Rotech Information BenefitsGenerous paid time Off and paid holidaysOvertime pay for non-exempt hourly positions based on business needsCommission for Account ExecutivesFixed and variable rate car reimbursement for Area Managers and Account ExecutivesEmployee discount programEmployee recognition programBonus and incentive opportunities Mileage reimbursement (when applicable for the position)Telephone reimbursement (when applicable for the position)EAP401k, HSA and FSA/Dependent Care FSAMedical, Prescription, Dental and VisionLife Insurance, Disability, Accidental death, Identity protection and Legal servicesMeru Health Mental health and Mercer SmartConnect Medicare programsLivongo Diabetes and High Blood Pressure programsHealthcare Bluebook and RX Savings solutions programsHEPB and TB vaccinations Make the Right Move and Submit your Resume Today The hiring manager reviews resumes and contacts applicants that have related experience to the applied position. To view the status of a position that you submitted your profile to, Sign into your account. All positions are posted for a min of 5 days and positions are opened until filled with a qualified applicant, generally no greater than 200 days. We appreciate your interest in Rotech Healthcare Inc. Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individuals with Disabilities. Rotech Healthcare Inc. recruits, employs, trains, promotes, transfers, separates from employment and compensates employees without regard to membership in, association with, or perception of race, color, age, gender, gender identity, religion, creed, national origin, ancestry, citizenship, marital status, veteran status, sexual orientation, physical or mental disability, pregnancy or any other personal characteristic protected by applicable federal, state and local laws governing nondiscrimination in employment in each locality where Rotech has employees.