Tennessee Orthopaedic Alliance

  • Credentialing Specialist

    Job Locations US-TN-Nashville
    Posted Date 2 weeks ago(10/31/2018 1:14 PM)
    Job ID
    2018-1455
    # of Openings
    1
    Category
    Central Business Office
  • Overview

    Our Credentialing Specialists play a crucial role at TOA to ensure our practitioners and facilities are enrolled timely in payer panels on behalf of the Tennessee Orthopaedic Alliance, including physicians, allied health professionals, ancillary, and facilities in Tennessee and Kentucky.

    Responsibilities

    • Responsible for oversight of payer application process including, but not limited to, both governmental and commercial programs, in relation to TOA employed and/or contracted practitioners, ancillary providers, and facilities (hospitals and surgery centers)
    • Prepares and sends application packets to appropriate providers at primary sites, requesting the return of required credentialing information and documentation
    • Reviews applications for completeness and assists the applicant in completing the packet requirements
    • Reviews, analyzes, and inputs provider file changes
    • Builds and maintains positive relationships with external payer contacts and provider representatives
    • Builds and maintains positive relationships with external facility contacts and their medical staff coordinators
    • Serves as a point of contact regarding credentialing issues with practice leadership and professional billing personnel
    • Communicates with providers, practice leadership, and professional billing personnel regarding credentialing status
    • Creates and maintains provider credentialing files including data entry into credentialing database, ECHO
    • Prepares and maintains various reports and summaries of credentialing/re-credentialing activities
    • Verifies provider professional license renewal (including DEA, ANCC, NCCPA, and BLS)
    • Tracks relevant CEUs earned, expiring, missing, and documentation per appointment and license requirements

    Qualifications

    • Bachelor’s degree in a healthcare discipline or high school diploma with additional, relevant experience
    • Knowledge of managed care credentialing procedures
    • Certified Provider Credentialing Specialist (CPCS) or working towards CPCS certification through NAMMS
    • 1-2 years healthcare experience in managed care and governmental credentialing, payer relations, and/or provider relations, including experience working for an HMO, PPO, or MCO plan
    • Knowledge of practitioner and facility credentialing/re-credentialing processes combined with experience completing managed care and governmental credentialing/re-credentialing enrollment applications
    • 1-2 years customer service and managed care contracting procedures experience
    • Experience using credentialing software such as: CAQH, ECHO

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