Contracting & Credentialing Specialist II
Experity
 Machesney Park, IL

Requisition Number: CONTR02215

Contracting and Credentialing Specialist II is primarily responsible for direct management of small to medium group clients as well building and maintaining professional relationships. CCC's work mostly independently with oversight from CCS, Manager and/or CC Director. CCC's oversee their assigned clients to ensure proper processes are followed based on industry standards. They frequently communicate with clients and other departments to share project results. CCS's are responsible for understanding and sharing state and federal regulations by payer and market for Urgent Care, Primary Care and Multispecialty Contracting and Credentialing.

Responsibilities

  • Build and maintain professional relationships with team members as well as with other departments, clients and payer representatives
  • Maintain confidential client, provider and company information at all times
  • Understand and perform the essential elements of the complete CC process including , but not limited to:
  • Various payor types ( commercial and government ) contract options UC, PCP, and Multispecialty at group and individual level Basic information pertaining to relevant provider types ( M,D., D. O., NP, and PA) and the credentials and specialty options for each
  • Crucial information to collect from payor in terms of CC compliance
  • All relevant provider types ( M.D., D.O., NP, and PA ) and the credentials and specialty options of each
  • Standard Operating Procedures developed internally and by each payor for compliance
  • Network access, including narrow or closed networks
  • Collection of crucial information from payor in terms of CC requirements and process by payer/market/contract type
  • Collections and recoding of relevant provider and client level information
  • Records all process, steps and results in CC software
  • Meets regularly with assigned CCS to provide necessary updates and to accept assignments
  • May participate in staff interviews
  • Perform job duties in accordance with the productivity and quality standards as defined by Experity
  • Other duties as assigned

Qualifications:

  • History of professional demeanor with co-workers, employees and clients/customers
  • Solid attention to detail
  • Effective in highly stressful and demanding environment
  • Ability to work with limited direct supervision
  • Proficient in data base user software
  • Proficient in preparation and analysis of spreadsheet software/Microsoft Excel
  • Ability to prioritize and work projects with simultaneous deadlines
  • Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problem

Education and Experience:

  • An associate’s degree in business in a related field or equivalent experience
  • Minimum of 2 years’ experience in health care industry
  • Knowledge of medical insurance terminology
  • Proficiency in Windows based applications and MS Office software products

Preferred:

  • Certification in healthcare billing or medical administration
  • Experience or training in Credentialing application completion
  • Experience or training Report preparation
  • Experience or training Credentialing Software, PECOS, CAQH, and other enrollment portals
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