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Credentialing Support Specialist

2 months ago

Baltimore MD United States Erickson Senior Living Full time

Location:

Erickson Senior Living

Erickson Senior Living, headquartered in Baltimore, Maryland is a national provider of senior living and health care with campuses in 11 states—and growing.  Erickson Senior Living develops and manages senior living communities and health services across the country. We achieve industry–leading results in customer satisfaction, driving high occupancy, and positive health outcomes.

The Credentialing Support Specialist is responsible for providing EHMG Medical Staff Services MSS) with clerical support in the completion of duties related to credentialing; re-credentialing; provider maintenance and payer enrollment. The incumbent must be highly flexible in that his/her duties will vary from day to day.  The incumbent must be able to handle and maintain varying administrative duties in a very professional manner; and also be able to work closely with the incumbent staff as needed. 

Compensation: Starting $22.00 per hour, commensurate with experience.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Credentialing

  • Assist in credentialing needs by determining the provider's initial eligibility for membership/participation.
  • Analyzes application and supporting documents for completeness and informs supervisor of the application status, including the need for any additional information.
  • Aid in completing initial or re-credentialing for eligible practitioners in partnership with the Medical Staff Services team.
  • Verifies and track expiring documents using acceptable verification sources to ensure compliance with accreditation and regulatory standards as requested.
  • Obtains and evaluates information from primary sources in partnership with supervisor.
  • Responds to queries regarding practitioners’ status to internal and external parties.
  • Perform tracking to ensure provider numbers are established and linked to the appropriate group entity promptly in partnership with the supervisor.
  • Perform a detailed review of the information used to submit the enrollment applications.
  • Maintain and update CAQH profiles for required providers in partnership with supervisor.
  • Attend and participate in weekly meetings with the team to discuss progress and feedback.
  • Communicates findings and/or resulting actions to supervisor and department peers.
  • Conduct internal and external audits of credentialing files to maintain current status.
  • Complete group and provider attestations as required.
  • Complete research on enrollment and credentialing for discipline/state and report findings as requested.
  • Communicate via telephone and written correspondence with insurance companies, patients, and physicians.
  • Completes data entry for providers information as necessary tools and reports.

Medical Staff Services Report Maintenance

  • Assist with special projects as assigned in partnership with the Medical Staff Services team.
  • Compile data and prepares reports in an organized manner.
  • Conduct on-line research and compile statistical and other reports
  • Reads and routes incoming mail. 
  • Locates and attaches appropriate file to correspondence to be answered by the department being supported.
  • Prepares outgoing mail and correspondence, including e-mail and faxes. 
  • Fax documents and copy material as needed for the department being supported.
  • Handle other administrative duties as requested.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Must possess above average computer skills
  • Must be knowledgeable of Microsoft Office
  • Must be willing to learn other application software relating to administrative functions.

EDUCATION and/or EXPERIENCE:

High School or GED is required.  One - two years healthcare administrative experience preferred. Bachelor’s degree in healthcare or equivalent years of work related experience required.

LANGUAGE SKILLS: 

Must be able to read, write, understand and communicate in the English language.

Erickson Senior Living, its affiliates, and managed communities are Equal Opportunity Employers and are committed to providing a workplace free of unlawful discrimination and harassment on the basis of race, color, religion, sex, age, national origin, marital status, veteran status, mental or physical disability, sexual orientation, gender identity or expression, genetic information or any other category protected by federal, state or local law.