Medical Staff Credentialing Specialist, Sr. jobs in Lorain, OH

Position Highlights :

• Hours : FT, Day Shift
• Lifestyle : Sandusky was voted Best Coastal Small Town in America . You will have the opportunity to enjoy living and working in this growing area along the beautiful shores of Lake Erie.
• Work / life : You will find support to help you manage your personal life while building a career.
• Employee-centric : Tuition reimbursement, loan forgiveness, comprehensive major medical, dental and vision insurance, paid time off, 401(k), health and wellness offerings, monthly employee events, and more.

About Firelands Health :

Our goal at Firelands Health is to be the best & preferred independent healthcare employer for the Sandusky Bay region.

Firelands Health is the area’s largest and most comprehensive resource for quality medical care. We are big enough to care for you, and small enough to care about you .

We are locally managed and governed as a not-for-profit healthcare facility, serving the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents.

Our mission is to provide excellent healthcare, promote community wellness, and improve the lives we serve.

Our Core ACE Values : Attitude : We choose to be positive and inclusive every day. Commitment : We are committed to exceed the expectations of those we serve.

Enthusiasm : We will work passionately to make a difference.

What you will do :

• Duties include the gathering, verification, and evaluation of confidential healthcare provider credentials. Contacting and following up with contracted network facilities to obtain documentation relevant to the credentialing process and data entry of all credentialing information provided by contracted facilities.
• Responsible for credentialing related to initial provider enrollment for Firelands Regional Medical Center acute facility, behavioral health employed providers, and all additional facilities under the appropriate tax identification numbers.

To include but not limited to, credentialing / recredentialing with Medicare, Medicaid, Anthem, MMOH, other major insurance payors and CAQH.

Insurance :

• Apply online for Medicare / Medicaid number or reassignments if provider number exists
• Add provider to insurance matrix, follow up with insurance monthly until provider credentialed
• Notify billing, department managers or liaisons of approved credentials and enrollments
• Complete all revalidations for providers
• Recredential and revalidate existing facility locations with all contracted payors.

Credential locations when the facility obtains a new contracted payor.

Add or delete locations as needed.

• Complete quarterly directory verifications with applicable payors.
• Assists as necessary with outside liaisons in efforts to complete out-of-state Medicaid provider enrollment documentation.
• Works closely with the Medical Staff and Human resources in obtaining required information for submission of provider enrollment documents.
• Ensures that all expiable are reviewed, obtained, and managed on a monthly basis according to the rules and policies. Maintains the confidentiality of all business / work and employed provider information.
• As necessary enters data completely and accurately, and has at least a working knowledge of the computerized credentialing software program(s) that are utilized in the Credentialing Office.
• Responsible for coordinating managed care insurance credentialing for providers. Submit credentialing applications; obtain effective dates, and provider identification numbers.
• Enters and attests to accurate and up-to-date data in The Council for Affordable Quality Healthcare (CAQH) database for providers.

Answers telephones and screens and routes calls in a professional manner; records and delivers messages promptly and accurately.

Uses own initiative in the development of appropriate forms, procedures, etc.

Utilizes computer equipment maintaining current working knowledge of multiple programs including Outlook, Word, Excel, and PowerPoint.

Participates in department performance improvement activities as assigned and attends required training.

Demonstrates Service Excellence and ACE.

Available for special projects as needed and performs other duties, as assigned.

What you will need :

• Experience working in the medical services profession required.
• Proven ability to interact effectively with people at all levels of the organization and representatives of outside agencies / firms.
• Ability to work in a fast-paces environment requiring multi-tasking.
• Ability to type 60 wpm. Proficiency in typing and word processing. Extensive keyboarding as part of daily routine work.
• Demonstrated ability to work effectively with physicians.
• Must possess a valid State of Ohio motor vehicle operator’s license and be insurable under Fireland’s auto policy. Employee must provide proof of personal automobile liability insurance coverage upon request.
• Ability to manage and prioritize work assignments.
• Strong organizational skills; experience coordinating projects or events a plus.
• Ability to maintain orderly files, records and reports.
• Ability to work in a safe and efficient manner and maintain an accident free work place, including ability to demonstrate a working knowledge of Medical Center emergency codes.
• Ability to comply with OSHA regulations and CDC stand and transmission-based precaution recommendations and to utilize proper personal protective equipment.
• Successful completion of a one hundred eighty (180) day probationary period.

Last updated : 2024-04-11