Credentialing Specialist

Location: Corporate Campus
Shift: FullTime – Monday – Friday

Education: High School graduate or equivalent
Certification:  CPCS, preferred, but not required.                                                                                      Experience:  Minimum of 2 to 3 years’ credentialing experience in the healthcare setting. Knowledge of modern office practices, procedures and equipment operations. Database and computer literacy. Professional communication skills, both written and verbal required. Excellent customer service, organization, planning and time management skill.

This position will be responsible for organizing, coordinating, monitoring and maintaining the credentialing and re-credentialing process. Ensures compliance with the appropriate accrediting and regulatory agencies, internal policies and procedures as well as the health plans. Responsible for the integrity of the credentialing database system and related applications. Works under the supervision of the Credentialing Director.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

Primary

1. Leads, coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.

2. Conducts thorough background investigation, research, primary source and secondary source verification of all components of the application file.

3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.

4. Prepares credentials file for completion and presentation to the Credentialing Committee, ensuring file completion within time periods specified.

5. Responds to inquiries from health insurance companies, interfaces with internal and external customers on day-to-day credentialing and re-credentialing issues as they arise.

6. Utilizes credentialing, optimizing efficiency, and performs query, report and document generation.

7. Monitors the initial, reappointment and expirables process for all physicians and other allied health professionals, ensuring compliance with regulatory bodies (AAAHC, CMS, federal and state), as well as policies and procedures, and delegated contracts.

8. Assist in preparing and submitting Credentialing Department projects, reports or assignments as needed to meet department initiatives, Health Plan reporting, and/or objectives.

9. Notifies Credentialing Director of any re-occurring credentialing issues or opportunities for process improvement.

10. Able to work independently with minimal supervision. Ability to work productively and well under pressure.

11. Ability to maintain confidentiality of privileged information gained.

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Medical Coder/Billing

Location: Corporate Campus
Shift: FullTime – Monday – Friday

Education: High School graduate or equivalent
Certification:  Must be a certified coder through AAPC (Certified Outpatient Coder) or a (Certified Coding Specialist).                                                                                                                     Experience: 2-3 years’ experience in medical coding in an ASC or Hospital setting.  CPT and ICD-10 proficiency, required.   Must have a good knowledge of medical terminology, anatomy, diagnosis and procedure codes. .

Additional Eligibility Qualifications: Must be able to plan and prioritize workflow and produce an acceptable volume of work accurately. Must possess strong analytical and research capabilities to review physician and nurse documentation. Good problem-solving skills and the ability to communicate clearly in writing and verbally to assigned providers and support staff. Must have accurate keyboard skills. Must have knowledge of Windows-based computer applications. Must be detail oriented and able to access data from varied resources and programs.

Summary/Objective: Obtain accurate reimbursement for healthcare claims.

Essential Functions

Reviews and edit charges for accuracy of codes and modifier usage based on established billing guidelines and completeness of charges/diagnosis by specialties.

Communicates coding changes and/or question to Physicians’ offices to appropriate staff.

Reviews Paragon work files on a daily basis and makes necessary changes to release charges to billing system.

Stays informed and up to date on coding issues by attending seminars. Possesses a comprehensive understanding of carrier specific, State or Federal billing guidelines.

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Account Payable Specialist

Location: Corporate Campus
Shift: FullTime – Monday – Friday

Education: High School graduate or equivalent, some college preferred.
Experience:  Two or more years of training or accounts payable experience required. Knowledge of inventory ordering and receiving through the accounts payable process required. Knowledge of accounts  payable and general  ledger accounts and experience with a computerized accounting system required. Proficiency in Excel. Experience in a healthcare setting preferred, but not required.

This position will be responsible include processing all vouchers and invoices for payment of supplies and services necessary for the operation of the Center.  Work involves compiling and tabulating data; checking documents for accuracy and completeness; maintaining vendor records; producing detailed related reports, and ordering supplies for the Corporate Office.  Additional responsibilities include assisting the Finance Manager with related issues and projects

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IT Analyst

Location: Corporate Campus
Shift: FullTime – Monday – Friday

Education: A.S. degree in computer science or similar discipline.  BA Information Technology, Computer Science or similar relevant field, preferred
Experience:  Minimum of (3) three years’ experience supporting computer networks in healthcare environment or educational background preferred.  A+ required.

This position will be responsible for a variety of tasks that range from Help Desk request to assisting the Information Technology Coordinator and/or Manager.  It will requires good judgement, excellent communication and organizational skills and discretion as it works closely with all departments both internal and external and directly with staff for maintaining systems and networks.  Assist the IT Manager and Coordinator as necessary with reporting and organization of the department.

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Health Information Analyst

Location: Corporate Campus
Shift: FullTime – Monday – Friday

Education: High School graduate or equivalent
Experience:  Minimum of (2) two years’ experience related experience

This position will be responsible for scanning documents, the maintenance, organization and security of all patient medical records, while maintaining strict confidentiality of these records.

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