Summary: Responsible for ensuring providers are credentialed, appointed and privileged with health plans, hospitals and patient care facilities as needed. Maintain up to date data for each provider in various credentialing databases/systems and ensures timely renewal of all licensure and certification requirements for insurance purposes. Works closely with Provider Onboarding & Scheduling Specialist.
Other information: Minimum 2 years experience in a healthcare office setting. Proficiency in the use of online credentialing databases and systems, i.e. NPI, PECOS, CAQH; Microsoft Office Applications (Word, Excel) and internet resources. Prior experience with medical billing and claims payment system requirements as it relates to provider enrollment. Ability to obtain Certified Provider Credentialing Specialist (CPCS) within two years.Experience with medical provider credentialing process, policies and procedures, including delegated credentialing requirements; familiarity with medical billing and claims payment system requirements as it relates to provider enrollment; demonstrated ability to work independently, with strong written and oral communication skills to effectively correspond with all levels of personnel and physicians/providers. Excellent attention to detail, with high degree of accuracy; ability to manage multiple projects efficiently and accurately. Requires exceptional critical thinking skills, sound judgment. Proficient use of Microsoft Office Applications (Word, Excel), credentialing software programs (NPI, PECOS, CAQH) and internet resources.
Responsibilities: Must be current with knowledge of online credentialing databases and systems Must have be extremely organized and detail-oriented in maintaining accurate provider records of all required licensure, professional liability, practice locations and any and all other verifications requested. Maintains current knowledge of accrediting body standards. Maintains confidentiality of provider and Group's information and documentation Familiarity with medical billing and claims payment system requirements as it relates to provider enrollment and the provider credentialing process. Maintains open communication with CBO Manager and Group's contractual payors. Maintains current knowledge of insurance payer base provider requirements and assures compliance with all regulatory requirements. Maintains open communication with medical credentialing staff at Beebe Healthcare
Competencies and skills: Essential: * Knowledge Of Office Equipment * Clear Communication Skills Both Written And Verbal * Knowledge Of Basic Computer Programs * Able To Keep Confidential Information Regarding Patients, Team Members * Able To Withstand Crisis Situations * Has Skills To Provides Customer Service To Patients, Team Members And Visitors * Experience With Excel, Power Point, Word, Visio, Etc.
Education: Essential: * High school graduate or equivalent
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.