Credentialing Assistant and Virtual Front Desk

The credentialing assistant will be a skilled professional with expertise in insurance follow-up. This role entails conducting weekly follow-ups for all commercial insurances selected by the client, ensuring comprehensive documentation is provided, and collaborating closely with insurance providers to facilitate the completion of enrollment (achieving in-network enrollment status) with each follow-up, as well as current contract inquiries. Each VFD member on your team will be assigned various duties using the VFD Responsibility Matrix. While all team members will be cross-trained to perform all duties in all clinics, everyone will have ownership over specific tasks and provide backup support to others

Responsibilities:

Provide a seamless experience for patients to receive therapy services such that the patient care experience exceeds their expectations from initial contact to discharge. All Patients arriving on time as scheduled, throughout their entire Plan of Care To collect all Over The Counter (OTC) $ due at time of service to support viable business operations.

1. Greet patients and check-in a. Check for any missing information

2. Collect OTC a. Collect OTC due at the time of service, provide receipt and record in EMR

3. Scheduling

a. New patients

b. Re-visits

c. Utilize cluster booking strategy to maximize clinical efficiency

d. Using cancellation or waitlist to fill open slots in schedule to ensure patients are meeting prescribed frequencies

e. Dropped patients

f. Patient Reactivations

g. Handle late arrivals and missed appointments

h. Use PT order slip to schedule out full Plans of Care with assigned therapists

4. Maintain POCs a. Utilize % prescribed tab on stat grid to monitor unsigned POCs

5. Maintain Referrals and request as needed

6. Patient Communication

a. Front desk email to be checked at regular intervals

b. Monitor website submissions

c. Monitor fax

d. Manage all incoming calls

e. Complete all confirmation calls unless an automated system is in place.

7. Provider Communication

a. Resolve patient schedule conflicts by communicating with therapists using IM.

b. Notify therapists of communication from physicians ASAP via IM

c. Fax all documentation to physician for signature, ie. Plan of Care (POC) and Re-Evals, within 24 hrs.

8. Manage patient cases in EMR

a. Create a patient's case in EMR , with data from intake paperwork.

b. Ensure all new and existing patients have current information on file. This includes but is not limited to: front and back photocopy of ID and Insurance card; Demographics; Patient privacy forms; Financial policy; Rx; VOB; appropriate outcome measures for IE.

c. Digitally file all new patient info via fax, digital intake, scan into patients chart.

9. Reporting

a. Run daily reports using EMR

b. Daily completion of Front Desk Stat Grid

c. Maintain the % of Prescribed tracking sheet so that all Patients are meeting their Frequency/Plan of Care as prescribed by their Therapist

10. Review Unbilled list and make necessary corrections for Rx, VOBs and demographics. Notify billing when corrected. Locate correct insurances on ‘Cred To Do’ spreadsheet, send inquiries for application and/or network status via phone call and/or email. Maintain detailed status notes for each client based on the following status:

Requirements

Hard and soft skills:

• Attention to detail (to verify credentials and documentation)

• Organization and time management (to track multiple applications and deadlines)

• Data entry and administrative skills

• Knowledge of credentialing processes and healthcare regulations

• Proficiency in credentialing software (e.g., CAQH, Modio, or Verity)

• Communication skills (to coordinate with providers, insurers, and regulatory agencies)

• Problem-solving (to address delays or missing documents)

• Confidentiality and compliance awareness

• Experience in healthcare administration or credentialing is a plus

• Familiarity with medical licensing and accreditation bodies

• Proficiency in Microsoft Office Suite (Excel, Word, Outlook)