Credentialing Specialist

Rotech Healthcare Inc. is a national leader in providing ventilators, oxygen, sleep apnea treatment, wound care solutions, diabetic solutions, and home medical equipment.

We empower patients to manage their health and treatment at home by keeping them engaged in their care and providing high-quality medical products, services, and outstanding customer care through hundreds of locations across 45 states.

We are seeking a dedicated Credentialing Specialist to join our team.

In this position, you will be 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.

• Administration of contracts, including review of payer contract language, policies, and procedures, provider manuals, billing rules, and guidelines.
• Analyzing monthly trend reports to identify additional research and/or updates required to Contract/Item Master.
• Assigning and updating necessary contract classifications for Managed Care/Government Reporting purposes.
• Assisting with projects at BCC when access to older billing rules, HCPCS, ICD-9, etc. is required to process claims in arrears.
• Communicating with Purchasing on appropriate base contract pricing-Contract.
• Communicating with the Billing Center, Central Intake, Sleep Central, and Locations regarding contract changes and/or updates.
• Completing payer credentialing and re-credentialing applications via hard copy, email, fax, or online based on payer specifications.
• Conducting conference calls with payors as required.
• Conducting Contact implementations with appropriate departments as well as payer in-services as required.
• Conducting/leading calls with payers regarding changes and/or updates to payer rules, processes, guidelines, pricing methodologies, and credentialing practices.
• Creating and maintaining job aids and training materials as it relates to contract and credentialing functions and systems used within CAD.
• Creating FOIA requests as appropriate.
• Filing yearly government reports such as Subcontracting report, CCR registration, Vets-100.
• Maintaining Contract Quick Reference Guides on the Rotech Home Page.
• Maintaining current Location database spreadsheet and COIs.
• Maintaining database of contracts within shared drive, e-Intake, and Contract Logix.
• Maintaining database of credentialing/re-credentialing within Laser Fiche and shared drive.
• Maintaining Location Dashboard information so assigned contracts appear on appropriately contracted locations.
• Maintaining monthly LANs updates and appropriate payer notification.
• Maintaining pricing and other updates within the online ordering system as required.
• Maintaining timely filing requirements outlined in Contracts to ensure claims drop as required by Contracted Payers into the timely filing cue within the billing center.
• Maintenance 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 Contracts.
• Monitors the release of solicitations daily and maintains a list of active solicitations within company database.
• Obtains and updates all Medicare and Medicare Non-Assigned Contracts as new HCPCS, Pricing, Modifiers, Certification requirements are published and available.
• 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 processing.
• Receives, 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 payers.
• Research 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 requirements.
• Research of competitor information.
• Researches and verifies contract requirements through various sources (billing/payment history, payor provider support, etc.) when there are no contracted requirements on file.
• Updates 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.

Employment is contingent on:

• Background investigation (company-wide).
• Drug screen (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 Experience:

• High school diploma or GED equivalent, required.
• Knowledge of Healthcare Contract Language and the ability to read and interpret Contract/Credentialing requirements and guidelines.
• Five years directly related experience in the medical industry working with HCPCS, CPT, and ICD-9 Codes.

Preferred Education and/or Experience:

• Paralegal Certificate, preferred.
• Bachelor's Degree or equivalent combination of college education and/or related work experience in healthcare, billing, and/or industry contracts, preferred.
• Lead/Supervisory experience.

Skills and Competencies:

• Ability to identify and resolve potential financial risk items/situations.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to think critically and analytically.
• Effectively communicate in English; both oral and written.
• Interpret a variety of communications (verbal, non-verbal, written, listening, and visual).
• Knowledge of Industry Contracts and medical billing.
• Maintain confidentiality, discretion, and caution when handling sensitive information.
• Multi-task along with attention to detail.
• Self-motivation, organized, time-management, and deductive problem-solving skills.
• Work independently and as part of a team.

Machines, Equipment, and Technical Abilities:

• Email transmission and communication.
• Internet navigation and research.
• Microsoft applications; Outlook, Word, and Excel.
• Innovative Medical Billing System (IMBS) preferred.
• Office equipment; fax machine, copier, printer, phone, and computer and/or tablet.

Physical Demands:

• Lift and carry office equipment at times.
• Requires sitting, walking, standing, talking, and listening.
• Requires close vision to small print on computer and/or tablet and paperwork.

Rotech Information:

• Benefits:
• 401k.
• Medical, Dental, and Vision.
• Life Insurance and Disability.
• Generous Paid Time Off and Paid Holidays.
• Employee Discount Program.
• Employee Recognition Program.
• Bonus and Incentive Opportunities.
• Mileage reimbursement (when applicable for the position).
• Telephone reimbursement (when applicable for the position).

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.