Credentialing Specialist RMG

Hiring Range

Overview
Functions as the primary liaison for all aspects of the onboarding process and Riverside Medical Group. Verifies credential documents (VA Medical License, Federal DEA, Board Certification and Visas), credentials and recredentials healthcare providers with contracted payors, reviews applications, monitors quality data and all applicable functions within the directive of quality control in the organization. Reports to the management staff at the organization and relies on instruction and pre-defined guidelines to perform various functions of the job, typically entering all information regarding providers into a database system of record. Recommends best practice or commonly used processes for quality improvement in credentialing.

What you will do

• Accurately complete and maintain the following Provider applications (both Initial and Re-credentialing/Renewals) as required (completion of applications includes conducting any necessary follow-up to ensure timely completion of process).
• Ensure timely Provider Onboarding to mitigate access issues for patients which helps to drive financial growth.
• Responsible for timely release of pending claims for newly credentialed providers to ensure financial stability for the Medical Group.
• Accurately builds, updates and maintains provider information electronically in all appropriate databases (Credentialing Database, CAQH, Echo, NPI, EMR/HER and patient accounting system) to ensure data integrity.
• Maintain accurate information in internal and external directories per CMS and other regulatory guidelines.
• Investigates problems related to credentialing, including but not limited to, payor participation status, supervising/collaborating physician agreements, billing, invalid place of service, CLIA and NPI denials issues. Responds within 2 business days. Researches legal sanctions regarding licensure to ensure compliance with Federal and State regulations. Finds and reports all issues prior to malpractice submission or upon discovery.

Qualifications

Education

• High School Diploma or GED, (Required)

Experience

• 2 years Active experience in credentialing/privileging (Required)
• in iCare/EPIC (Required)

Licenses and Certifications

• Certified Provider Credentialing Specialist (CPCS) (Preferred)

To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.