We are recruiting for a Credentialing Coordinator, Direct Bill to join our Kindred Rehabilitation Services Division in St. Louis, MO.
The Credentialing Coordinator is responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process of all Physical Therapists, Occupational Therapists and Speech Language Pathologists (Therapists) who provide therapy services within our Direct Bill Agency locations. Works under the supervision of the Billing Manager in the St. Louis, MO support center office.
Duties and Responsibilities :
Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
Establish and maintain data entry in ProView for CAQH general data collection information.
Reviews of all components of the application file and assists Therapists in completing provider enrollment applications.
Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
Prepares credentials file for completion and presentation to the managed care plan/insurance, ensuring file completion within time periods specified.
Verify provider and group information with insurance companies (e.g. address maintenance, provider roster maintenance, contracted plan maintenance, etc.)
Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and contract issues as they arise.
Assists with managed care delegated credentialing audits, conducts internal file audits.
Utilizes the credentialing database and applicable tracking applications, optimizing efficiency, and performs query, report and document generation when necessary.
Responsible for the accuracy and integrity of the credentialing database system and related applications.
Monitors the initial, re-attestations and expirables process for all credentialed Physical Therapists, Occupational Therapists & Speech Language Pathologists, ensuring compliance with policies and procedures identified in the Plan contracts.
Performs miscellaneous job-related duties as assigned.
Knowledge, Skills, and Abilities:
Ability to communicate effectively, both orally and written.
Ability to work in a fast-paced environment.
Ability to multi-task effectively.
Knowledge of related accreditation and certification requirements.
Knowledge of medical credentialing.
Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
Working knowledge of clinical and/or Agency operations and procedures.
Informational research skills.
Ability to use independent judgment to manage and impart confidential information.
Database management skills including querying, reporting, and document generation.
Ability to make administrative/procedural decisions and judgments.
Advanced knowledge of Microsoft Office (Excel, Word, Access, Outlook)
Knowledge and understanding of HIPAA and CMS guidelines
Experience related to managed care Allied Health credentialing is preferred.
Medical billing knowledge and experience is preferred.
Bachelor's degree or; Associate's degree plus 1 year of professional office experience or; High school diploma or GED and 3 years professional office experience.
Professional office experience – may come from a variety of areas, but a background in healthcare is preferred.
Depending on a candidate's qualifications, this position may be filled at a different level.
If you are a current Kindred/RehabCare employee Click Here .