Insurance Credentialing SpecialistHillcrest Family Services, DUBUQUE, IA
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Founded in 1896, Hillcrest Family Services is a not-for-profit health services and education provider serving over 20,000 individuals each year. With primary programming and administrative offices in Dubuque, Hillcrest also operates programs in Cedar Rapids, Iowa City, Clinton, Washington, Ottumwa, Monticello, Maquoketa and Thomson, IL. The agency operates with an annual budget in excess of 20 million, has 500 employees, and is accredited by the Joint Commission and Coalition for Residential Education (CORE).
Job Summary: Oversees insurance credentialing progress for agency. Performs other accounts receivable functions as assigned.
- High school diploma or equivalent required. Proficient at computer keyboarding and using software applications such as Microsoft Excel and Word.
- Previous experience working with insurance companies, billing, etc., in a health care setting preferably including use of electronic health records and use of billing clearinghouse(s) required.
- Working knowledge of insurance CMS 1500 billing forms and familiarity with CPT Codes, ICD-10 codes and medical terminology required.
- Previous experience with Cerner, credentialing, and Zirmed preferred.
Duties and Responsibilities
- Coordinates information for enrollment and terminations of all providers, as well as overall agency required applications.
- Oversees enrollment of practitioners with all appropriate client health plans; monitor and report on progress of each practitioner to facilitate scheduling by payment source.
- Prepares credentialing applications for all initial applications and completes re-credentialing for agency and individuals in an accurate and timely manner.
- Monitors enrollment with Medicare, Medicaid, commercial insurances and hospital affiliations, including staying up to date on changes in contracts and re-credentialing requirements by reimbursement source and provider.
- Verifies provider and group information with insurance companies (addresses, provider rosters, contracted plans, provider numbers, etc.)
- Maintains timely and accurate data entry in, and periodically revises, practitioner and payer data in the credentialing database.
- Maintains practitioner paper and electronic data files for agency practitioners. Collects and updates necessary provider information and documentation and verify the information where possible.
- Coordinates with Human Resources information needed for the Joint Commission credentialing and privileging process.
- Ensures providers are entered in CAQH prior to beginning the credentialing process and that provider reports are accessible. Establishes and maintains data entry in Council for Affordable Quality Health Care (CAQH). Uses the QACH system to submit practitioner data as required by some client health plans to credential individual practitioners.
- Keeps Finance and scheduling staff well informed of activities and of any significant problems.
- Trains staff to assist with credentialing as needed to ensure departmental understanding and back-up for this position.
- Assists with other team members with billing and reconciliation tasks as needed.
- Maintains confidentiality of credentialing and sensitive provider information.
- Other duties, including special projects, as assigned.
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