Credentialing and Contracting Specialist

at CHC-SEK in Pittsburg, Kansas, United States

Job Description

GENERAL DESCRIPTION

This position is a part of the compliance/credentialing team. This position assists with processing the credentials and privileges of all providers in order to verify accuracy and compliance with state and federal regulations and HRSA and FTCA deeming requirements. This position is responsible to maintain database of practitioners' training, education, licensing. This position supports the organization in submitting provider/facility applications to payers and is responsible for credentialing providers through third party payers.

Requirements

ESSENTIAL DUTIES

1. Knowledge of and adheres to CHC/SEK’s Credentialing policy and procedure and ensures process is completed timely.
2. Completes research, reference and background verification on all providers prior to hiring.
3. Verifies the professional credentials, references, claims history, fitness and professional review organization’s findings. 
4. Uses all available resources to verify provider applications, education, licensing and references following State and Federal guidelines for primary source verification. 
5. Communicates credentialing findings to supervisor.
6. Creates and maintains database information for providers, including, but not limited to CAQH, KMAP, NPPES, NPI and other license, certification or professional membership that may be required to practice.
7. Maintains accurate and complete credentialing file for all providers. Files are kept confidential and secure.
8. Coordinates new provider information, such as DEA, license number and NPI, into the electronic health record system for billing purposes.
9. Submits accurate and complete application information to payers to receive billing number to allow submission of claims for facilities and providers.
10. Responsible for third party payer contracts are signed by all parties necessary to ensure plan enrollment.
11. Completes EFT and ERA enrollment as part of the enrollment process to ensure electronic payments and claims submissions. 
12. Track progress of licensing requirements for providers as a part of payer enrollment.
13. Provides accurate, complete and timely credentialing and privileging information for the re-credentialing process. 
14. Actively communicates with applicants, employment references and others as necessary to ensure timely completion of the credentialing and contracting process.
15. Perform all duties, services and documentation in full compliance with CHC/SEK policies and procedures.
16. Performs other duties as assigned.