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Contracting Credentialing Specialist

Plano, Texas | Contract To Hire

Post Date: 08/24/2017 Job ID: 4559 Industry: Admin

JOB PURPOSE:
The Contracting & Credentialing Specialist has responsibilities in all aspects of contracting in the Billing Department. This includes, but is not limited to: pre-contracting research for potential contracts, submitting applications for contract reviews, reviewing contract terms and performing contract-compliance audits. This job purposes also includes quality checks to ensure Billing compliance standards are met.

KEY ACCOUNTABILITIES/ESSENTIAL FUNCTIONS:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Thoroughly track all forms of contract-related communication & documents
  • Research provider, hospital and insurance network relationships
  • Run Reimbursement Reports to determine levels of contract pursuit
  • Generate various Billing-specific reports for analyzation and dissemination throughout department
  • Maintain various Medicare licenses and ensure credentialing is performed as needed
  • Regular and timely attendance
  • Maintains strictest confidentiality and adheres to all HIPAA guidelines and regulations

PERFORMANCE FACTORS:
  • Dependability: The employee can be depended upon to complete work in a timely, accurate, and thorough manner and is conscientious about assignments.
  • Being dependable also includes promptness, regular attendance and compliance with work/departmental policies, procedures and protocols.
  • Communication & Contact: The employee communicates effectively both verbally and in writing with superiors, peers, and individuals inside and outside the Company.
  • Relationship with Others & Attitude: The employee works effectively and relates well with others including superiors, peers, and individuals inside and outside the Company. The employee exhibits a professional manner in dealing with others and works, to maintain constructive working relationships.
  • Self-Motivation & Initiative: The employee asks questions concerning projects and assigned tasks. The employees volunteers to take on addition responsibilities to meet the needs of the department.

SKILLS AND ABILITIES
  • Must have excellent Microsoft Office Suites skills with a specific focus in Excel, as this position requires a high volume of detailed generation and formatting of reports performed in Excel
  • Ability to type a minimum of 50 wpm with no errors
  • Excellent written and verbal telephone skills to include proper grammar with a positive and friendly demeanor
  • Ability to relate and communicate with all levels of management
  • Ability to maintain a high degree of professionalism and integrity
  • Possess strong and effective customer service skills
  • Display excellent judgment at all time
  • Absolute attention to detail and follow-up
  • Must be a team player, be flexible, and be a good listener with a high level of patience
  • Ability to manage sensitive, confidential issues
  • Ability to work in a fast-paced deadline oriented environment
  • Ability to multi-task and properly prioritize workload
  • Possess strong organizational and time management skills

REQUIRED EDUCATION AND EXPERIENCE
  • High School diploma or equivalent

PREFERRED EDUCATION AND EXPERIENCE
  • One to two years of health insurance experience
  •   Knowledge of Medical Terminology

POSITION TYPE/EXPECTED HOURS OF WORK
This is a full-time exempt position. Days and hours of work are Monday through Friday, 8: 00 a.m. to 5: 00 p.m. with frequent extended daily work-hours to include possible weekends as business needs demand.

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