Credentialing Specialist

3 hours ago

Colorado Springs, Colorado, United States Open Bionics Full time
Job Title: Credentialing Specialist

Open Bionics is seeking a highly skilled Credentialing Specialist to join our team. As a Credentialing Specialist, you will be responsible for managing all aspects of the licensing and credentialing of Open Bionics. This includes seeking, managing, and onboarding new state and federal medical insurance contracts, as well as monitoring policy changes and updating the team on any developments.

Key Responsibilities:
  • Manage the maintenance of complete and accurate documentation regarding Open Bionics' facilities, ownership, and management to enable licensing and credentialing applications and insurance agreements.
  • Respond in a timely manner to federal, state, local agencies, and insurance companies in relation to the Company's licensing and credentialing obligations.
  • Conduct research, maintenance, and coordination of all federal, state, and local licensing requirements.
  • Expert completion of initial and renewal applications.
  • Manage Open Bionics' database to ensure accurate recording of data of all licenses and agreements with federal, state, local organizations, and private health insurers.
  • Manage the completion of all revalidation or re-credentialing requests from Medicare, state Medicaid agencies, and private health insurance companies.
  • Prepare and submit all licensing applications for new locations of the company to obtain the relevant licensing and accreditation.
  • Contact insurance companies to initiate participation in their DME provider networks, including letters of interest, negotiations, and applications.
  • Maintain and manage the company's database of provider insurance contracts.
  • Keep colleagues and management up to date in relation to new insurance contracts, fee schedules, and updating the relevant databases.
Requirements:
  • High School Diploma/GED.
  • Minimum of three (3) years experience in a credentialing and insurance onboarding role.
  • Knowledge of managed care and integrated health systems.
  • Knowledge surrounding HIPAA, Anti-Kickback, Fraud, Abuse & Waste.
  • Previous contracting, provider relations, and/or provider reimbursement experience.
  • Comprehensive project management abilities.
  • Excellent oral and written communication and presentation skills.
  • Excellent organizational skills and ability to manage multiple projects simultaneously.
  • Excellent interpersonal skills and ability to develop effective working relationships with both internal and external customers.
  • Strong negotiation skills.
  • Understanding of legal, business, and insurance operations principles.
  • Proficient in word processing and spreadsheet software.
Desirable:
  • Experience with Netsuite (CRM System).
  • Experience in Durable Medical Equipment (DME) and/or Prosthetics/Orthotics related organizations.
  • Experience in working in a start-up company.
  • Any relevant credentialing certifications.

Open Bionics is an Equal Opportunities employer. If you are disabled and require any reasonable adjustments, please contact [email protected]. We welcome enquiries from everyone and we value diversity in our workplace. We may operate positive action measures to encourage people from under-represented groups to apply and help them overcome disadvantages in competing with other applicants. If you are successful, you will be expected to provide proof of your right to work in the USA.

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