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Contracting & Credentialing Specialist

2 months ago

Idaho Falls, United States BRAD HALL COMPANIES Full time
Job Details

Job Location
J4K Coronado - Idaho Falls, ID

Travel Percentage
Negligible

Job Category
Admin - Clerical

Description

Just 4 Kids Health is currently seeking a Contracting and Credentialing Specialist to maintainphysician privileging and provider credentialing. Candidates for this position will have aknowledge of negotiating in-network contracts with insurance carriers, be familiar with agency standards and requirements for credentialing licensed providers. The Contracting & Credentialing Specialist will collaborate with staff to ensure a unified approach to the delivery of service.

Contracting and Credentialing Specialist will:
  • Credential all providers in the practice. This includes Medicaid application and Managed Care credentialing for all providers.
  • Credential facilities with insurance carriers.
  • Negotiate in-network contracts with insurance carriers for physicians and facilities.
  • Maintain contracts.
  • Apply for and maintain hospital privileges for providers in the practice as needed, and work closely with hospital credentialing department.
  • Meet with providers to gather, review and provide guidance on completion of credentialing packets.
  • Coordinatethe input of physician information into CAQH and Medicaid and database.
  • Oversee input of physician documents into database and proper maintenance of Medicaid documents.
  • Continuously verify the status of provider licenses, DEA, CSR certificates and specialty certificates.
  • Ensure provider information is forwarded to the appropriatechannels on a routine basis.
  • Maintain provider files for credentialing purposes.
  • Regularly update physician relevant information and send to all payers.
  • Contact appropriate organizations upon hiring of new providers.
  • Act as backup for medical biller for both J4K Urgent Care and Primary Care.
  • Conduct Medicaid reviews
  • Negotiate reimbursement rates
  • Identify and resolve denials of high dollar medical claims
Qualifications

The preferred candidate for the Contracting and Credentialing Specialist Position will have the following qualifications:
  • Minimum High School Diploma/G.E.D. Minimum
  • 3+ years of experience with physician and facility credentialing is required.
  • Minimum 3+ years of experience with negotiating in-network contracts directly with insurance carriers for physician and facilities required.