Premier Orthopedics and Sports Medicine is looking for a Credentialing Specialist to work at our Newtown Square, PA corporate business office.

At Premier Orthopaedics, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

ESSENTIAL FUNCTIONS

• Reviews and completes hospital and payor applications for all health care providers.
• Completes and submits necessary applications for changes to provider practicing locations.
• Follows up with payors to ensure the application is processed with no pending items needed.
• Submits re-credentialing applications in a timely manner.
• Maintains effective dates and provider ID numbers for each provider/payor.
• Maintains, updates, and re-attests CAQH profiles for each provider as required.
• Completes Medicare and Medicaid in a timely manner.
• Completes verification forms/letters for outside facilities.
• Enters provider data in database and status notes for documentation purposes.
• Works with payor representatives to resolve provider enrollment issues causing gaps in billing or payment denials.
• Maintains billing insurance grid, provider insurance grid, and each physician’s spreadsheet up to date on current insurance changes.
• Tracks and maintains physician licensure(s), certification, and CME credits.
• Maintains practitioner credentialing files.
• Maintains practitioner electronic file by keeping all applications/licensure current.
• Maintains all renewal applications for both hospitals/insurances.
• Responds to provider office staff to resolve payor problems such as authorization issues, inaccurate participation status and any other issues that cause barriers to patient care.
• Completes initial facility appointment applications for new providers for medical staff privileges.
• Facilitates reappointment applications to ensure providers maintain active medical staff privileges.
• Follows all practice/site-specific protocols pertaining to this job description.
• Other duties as assigned.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• Minimum of three-four years of related experience.

REQUIREMENTS

• Must be able to communicate effectively with physicians, staff members, patients, and the public and be capable of establishing good working relationships with both internal and external stakeholders.

KNOWLEDGE

• Advanced computer knowledge, including Window based programs.
• Knowledge of the credentialing process.
• Knowledge of credentialing paperwork, timelines, and regulations.

SKILLS

• Skill in providing excellent customer service.
• Skill in establishing good working relationships with both internal and external stakeholders.
• Skill in organizing daily work assignments for various providers.
• Skill in managing multiple work assignments and setting priorities.

ABILITIES

• Ability to multi-task in a fast-paced environment and work well under pressure.
• Ability to be detailed oriented with strong organizational skills.
• Ability to work independently and as part of a team.
• Ability to communicate clearly and effectively.