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Credentialing Coordinator

  • Location: Cumberland, 02864
  • Salary: 27.34
  • Job Type:Contract

Posted 7 days ago

Interested in getting into the high-in-demand healthcare field? Check out this opportunity!
 
Position: Credentialing Coordinator 
Location: Cumberland, Rhode Island 02864
Hourly Rate: $ 27.34/hr.
Term: 4 Months Contract

Day-to-Day Responsibilities:
  • Maintain existing contracts:
    • Complete, maintain, and monitor applications for Initial enrollment and Revalidation with Government Payers and some Commercial for Clinics and Providers in order to ensure active participation in Medicare and Medicaid programs.
    • Maintain working knowledge of statutory regulations for Medicare, Medicaid, and Commercial enrollment and claims submission requirements.
    • Ensure timely and accurate Group/Provider enrollment applications are submitted for Medicare and Medicaid programs.
    • Minimize deactivation of government applications by following quality control procedures.
    • Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information.
    • Receive escalated claim issues from other internal departments and coordinate contact with payer to develop solutions and when brought to resolution; communicate to others internally as appropriate.
  • System updates, project work load, reporting, and communications:
    • Update Credentialing and Billing systems with Provider information upon inquiry or receipt from payers.
    • Create content for state summary, policy and procedures, maintain existing training modules.
    • Research potential issues, develop solutions and bring to resolution.
    • Send communication/updates to the field as needed.
  • Financial Analysis:
    • Research and analyze trends ( i.e. claims, providers, clinics) in order to make recommendations for process improvements and system efficiencies
    • Keep an issue log with all provider payer issues for your states each week.
    • Work with SPM and CPM’s to ensure that all providers are enrolled in the correct locations, report on all discrepancies and plan for process improvements.
    • Review all Claims on manager hold/hold – i.e. trends, errors, enrollment in new locations, correct ins. Pkg. review non-billable services, etc.
  • Establish/create and maintain payer enrollment tracking system:
    • Ensure all enrollments and specific data is maintained timely and accurately in the tracking system so all information can be easily referenced.
    • Identify and improve tracking system for efficiency.

Is it a good fit? (Requirements):
  • 3 years of overall provider enrollment related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part B enrollment processes or previous work experience in regulatory environment.
  • 2 years CAQH experience
  • High school diploma or GED

Candidates will be responsible for following the client's COVID-19 protocols. Please refer to your MATRIX representative for specifics.

About Us

At MATRIX, we expertly match talented professionals with job opportunities to elevate careers. Since 1983, we have placed thousands of professionals at innovative clients across every industry ranging from small startups to Fortune 50 companies. It’s why we’re consistently in the top 25 of all U.S. IT staffing firms and why our consultants rate us well above the industry average, earning us ClearlyRated's Best of Staffing awards year after year. People come to us for a job, and stay with us because of our top-notch consultant care.

MATRIX is and Equal Employment Opportunity employer including disability and veteran and provides reasonable accommodations for all qualified individuals.  Supporting medical or religious documentation will be required where applicable. If you are a qualified individual you may request a reasonable accommodation under the American Disability Act (ADA). If you are a person with a disability needing assistance applying, or at any point in the hiring process, please email us at MATRIX_HR@MatrixRes.com. To ensure a quick response to your request, please use the words “Accommodation request” as the subject line of your email.