What You’ll Bring:
The ideal employee will bring a strong knowledge base of NCQA and HIPAA standards for credentialing clinicians for our outpatient division. You’ll champion the Select Medical culture of teamwork, building trust, superior quality, and show the ability to own your own future.
The Impact You’ll Make:
- You will be an important contributor to ensure the division can maintain a high-quality network of clinicians providing quality care to our patients. You will have opportunities to experience personal and professional growth.
- Manages all phases of the Non-Delegates Payor Enrollment process for providers and facilities. Responsible for making a determination on why claims rejected. Partner with external sources to determine the best resolution.
- Partner with internal resources (Contracting department) to help determine the payor credentialing requirements.
- Responsible for understanding all payors and their requirements and for building relationships within a specific territory to have the ability to know what questions to ask and to whom to get a resolution.
- Review all contracting for accuracy and partner with payors to ensure the proper credentialing status.
- Complete Payor Enrollment and re-credentialing for facilities and practitioners with all applicable, contracted, Non-Delegated Payors.
- Work with CVO Coordinators for the collection of all payor enrollment requirements, such as signature pages, licensure, proof of Liability, et al.
- Complete and track all health plan credentialing and enrollment for practitioner/facility.
- Serve as a company source of information regarding the status of non-delegated payor credentialing activity.
- Maintain the credentialing database with relevant payor tracking and data.
- Monitor provider and facility status in both internal and external data systems relating to nondelegated payor enrollment.
- Maintain all payor enrollment portals such as CAQH, with current information, such as contact information, licensure effective dates and current certificate of liability data
The “technical” details:
Education: Associates degree or a minimum of 2 years’ experience in the credentialing field or related healthcare field
Proficient in Windows (Word, Excel, and Access
Ability to be professionally assertive with both internal and external partners to be influential in finding resolutions
Good oral and written communication skills with the ability to interact professionally and positively within all levels of the organization
What We Love To See:
- Collaboration and Team Orientation – a team-first enabler, manage diverse viewpoints, a consensus builder, a confidence builder, an insight provider, a perspective builder, and a relationship builder; a trusted influencer of colleagues, key leadership, and stakeholders
- Determination – problem solver, achievement-oriented; persistent and resilient; comfortable in a fast-paced environment; unafraid to change, unafraid to learn, demonstrate a fierce commitment to the achievement of challenging goals
- Ability to Own Your Future – possesses the big picture, promotes vision and innovation, commitment to connecting with leadership to achieve objectives; seeks opportunities to cross-train and learn; manages career growth
- Adaptable – do what’s right for the team, partners, patients, employees, leadership, and the Company; open to mentors and coaching, remain calm and optimistic under pressure and adapts well to unexpected situations; comfortable dealing with ambiguity and uncertainty; self-reflecting; solicits and embraces constructive feedback
- Enthusiastic and Positive – open, genuine; able to create an environment of excitement and positive motivation that leads to an emotional connection with the team; sees solutions rather than problems; builds trust
- Mission Centric – passionate about being a connected member of our team that is focused on creating the best patient and employee experience in the industry by focusing on relevant experience and expertise for the benefit of the organization.
Select Medical is an EOE.
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