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Payer Credentialing Specialist
4 months ago
About Sound:
Headquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape — with patients at the center of the universe.
Sound Physicians offers a competitive benefits package inclusive of the items below, and more:
- Medical insurance, Dental insurance, and Vision insurance
- Health care and dependent care flexible spending account
- 401(k) retirement savings plan with a company match
- Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
- Ten company-paid holidays per year
About the Role:
The Payer Credentialing Specialist is responsible for researching payer credentialing and billing issues and will work in conjunction with the Manager of Payer Credentialing in order to identify issues with the external Provider Enrollment vendor and the internal payer credentialing team. Additionally, will utilize a variety of proprietary and external tools in order to research and resolve provider enrollment issues. This may require contact with the Hospital Coordinators, operation personnel and/or insurance companies via phone, email or website.
The Details:
In this role, you will be responsible for:
- Working closely with external payer credentialing vendor on notification of a provider's start, welcome packets, provider documentation and ensuring the provider is in all systems
- Researching and resolving billing vendor holds from insurance carriers forwarded to Sound Physicians by the external billing vendor using a variety of methods, dependent on the reasons
- Performing follow-up with Sound Physicians market locations as needed in order to research and resolve provider enrollment issues
- Performing follow-up with insurance payers via phone, email or website to resolve payer credentialing issues
- Managing the completion and submission of provider enrollment applications
- Performing tracking and follow-up to ensure provider numbers are established and linked to the appropriate Sound Physicians group entity in a timely manner
- Understanding specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations
- Maintaining documentation and reporting regarding provider enrollments in process
- Retaining records related to completed payer credentialing applications
- Working closely with program site management and Sound Physicians central services resources to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
- Establishing close working relationships with privileging coordinators, contracting department, medical management, and payer contacts
- Performing other duties and special projects as assigned
- Maintaining strict confidentiality with regard to protected health information and understanding and adhering to Sound Physicians HIPAA Privacy & Security policies and procedures
- Maintaining strict confidentiality regarding provider information
What we are looking for:
A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience:
Values:
- Work Ethic – Dedication to getting the job done well and on time, regardless of circumstances, a can-do attitude
- Communication: The ability to speak, write, and listen clearly and consistently
- Relationship Building and Maintenance: The ability to create and nourish healthy, strong relationships, as the face of Sound
- Teamwork: Demonstrates the ability to pull people together into highly effective teams along with ability to work in a highly matrixed organization
- Critical Thinking: Demonstrates the ability to be proactive, anticipate needs; ability to make good decisions with incomplete, ambiguous information
- Adaptability – Demonstrates flexibility and a willingness to change as circumstances evolve and be coachable
- Resourceful – Proactive willingness to utilize available information and tools to figure things out, not afraid to ask questions when necessary
- Commitment – Demonstrates a dedication to the job, project, organization, customer/clients, and co-workers
- Self-Motivated: Proactively jumps in to start a task or project with limited direction; asks to take on more responsibility and what is next
- Customer-focused: Puts the customer's (internal and external) needs first and makes customers their top priority
Knowledge:
- High School Diploma or GED required
- Expertise in Microsoft software products including Word, Excel, and Outlook
Experience:
- 1 + years of Payer Credentialing experience required
Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.
This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.
