PURPOSE AND SCOPE:
The Sr. Credentialing Specialist supports Fresenius Medical Care’s core values and adheres to Fresenius Medical Care’s Compliance Program, including following all regulatory and policy requirements. The incumbent utilizes expertise regarding federal and state regulations governing certification and licensure to provide credentialing guidance and support to the related business.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Serves as liaison to new onboarding providers to collect, save, and data enter all necessary credentialing information and documents.
- Provide weekly status updates to leadership on new onboarding providers.
- Provides information, support, and clarification to related staff and management regarding the regulatory requirements which pertain to continued participation in related health plan and networks.
- Monitors facility privileges expiration dates to ensure related staff completes re-credentialing applications in accordance with department procedure.
- Monitors Traditional Medicare and Traditional Medicaid re-validation due dates to ensure related staff completes re-validation applications in accordance with national and state government regulations.
- Provides support in resolving third party payor claim rejections for not-contracted.
- Researches and seeks to resolve the claim rejection. Obtains clarification from related parties such as payor when necessary.
- Leads team in the maintenance and updating of an organized credentialing and contracting filing database system.
- Monitors expiring/expired licenses and certificates.
- Purges files of expired and unnecessary documents and reports.
- Identifies and recommends techniques to improve workflows on an ongoing basis and to ensure compliance.
- Maintains a report of all applications and distributes to primary contacts, such as management and leadership team.
- Requests and/or develops reports required by payor
- Creates training tools for related staff, as needed
- Escalates issues to supervisor/manager for resolution, as deemed necessary.
- Builds productive working relationships.
- Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
- The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SUPERVISION:
EDUCATION:
- High School Diploma required; Associate’s Degree desirable.
EXPERIENCE AND REQUIRED SKILLS:
- 2 – 4 years’ related experience.
- Strong organizational skills, with the ability to administer multiple tasks and prioritize.
- Excellent communication skills, written and oral, with the ability to communicate to all levels of personnel.
- Excellent customer service skills.
- Strong personal computer skills.
- Excellent organizational and analytical skills.
Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.
Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors
