Insurance Credentialing Specialist
Compensation: $65,090.00 - $95,690.00 /year *
Employment Type: Full-Time
Industry: Financial Services - Insurance
Associates in Ophthalmology (AIO)?is a well-established multi-specialty independent physician owned practice committed to excellence, since its establishment in 1899. Headquartered in West Mifflin, AIO adds to the patient experience by seeing patients at all of our 11 locations across the region. AIO is the parent company for the Associate Surgery Centers (ASC), where 95% of eye surgeries are performed in-house.
Everyone at AIO and ASC excels at providing and expanding quality eye care in a comfortable, caring and cost-effective environment. We will treat our patients as we would our families. We will strive to reach our maximum potential individually and collectively.?
AIO and ASC are committed to ensuring the best possible patient?and staff experience.?
Job Summary and Responsibilities
Under the direction of the Finance Manager, the Insurance Credentialing Specialist will be responsible for all aspects of the credentialing, re-credentialing and privileging processes for all medical providers who provide patient care. This role will ?be maintaining up-to-date data for each provider in credentialing databases and online systems. These tasks include, but are not limited to the following:
- Compiles and maintains current and accurate data for all providers
- Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed
- Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
- Sets up and maintains provider information in online credentialing databases (CAQH)
- Tracks license and certification expirations for all providers to ensure timely renewals
- Ensures practice addresses are current with health plans and other entities
- Processes applications for appointment and reappointment of privileges to ASC
- Audits health plan directories for current and accurate provider information
- Maintains confidentiality of provider information
- Term providers with the different insurance carriers who are no longer with the practice
- Assist insurance AR person with any denials related to provider participation with the insurance plans
- Take calls directed to finance department from insurance carriers? regarding credentialing
- Attend required meetings. Participate in insurance meetings/seminars to keep current with changes in insurance matters
- Conform to all AIO policies and procedures including punctuality, attendance and dress codes
- Duties and responsibilities may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing
- Other duties as assigned by management, as well as current duties.
Skills and Qualifications:
- High school diploma or equivalent is required.
- 1-3 years minimum experience in medical office; insurance and credentialing experience
- Excellent communication skills, written and oral
- Strong organization skills and attention to detail
- Ability to manage multiple tasks simultaneously
- Willingness to learn
- Must be proficient with Windows-based applications.
Perks and Benefits:
- Health and dental insurance,
- Life, Spousal Life, Child Life Insurances,
- Short and Long Term Disability,
- 401k with employer match,
- PTO and Holiday Pay.
AIO is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.
Associated topics: adjuster, bodily, casualty, claim adjuster, claimant, damage, fraud, investigate, liability, title examiner
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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