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Credentialing Administrator

Company: LifeScan Labs
Location: Skokie
Posted on: May 14, 2022

Job Description:

Position Summary:

The Credentialing Administrator is responsible for completing and submitting credentialing
applications, enrollment packets, and maintains credentialing status with government and
commercial payers. The Administrator ensures in-network status with contracted payers remains
active to minimize risk to revenue loss, out-of-network payment reductions or authorizations.
Organizes and maintains payer contract agreements, fee schedules, and credentialing records by
payer for Lifescan Labs.

Essential Job Functions:

--- Submits initial credentialing applications, enrollment packets, and processes re-credentialing
applications timely and accurately to minimize impact on out-of-network payments, revenue loss,
and surprise billing.
--- Reviews payer mix from clients and compares to Lifescan Labs payer mix. Initiates contracting
process for Director.
--- Maintains accurate detailed records of all contracting and credentialing work in addition to emails
and/or conversations with payers, networks, and government entities.
--- Maintains accurate Lifescan Labs profile on CAQH, PECOS, NPPES, and CMS databases.
--- Processes credentialing paperwork or electronic submissions and recertification maintain
credentialing status with all payers.
--- Ensures contracting, credentialing, and re-credentialing records are accurate. Modifies records as
appropriate to maintain accuracy of documents.
--- Reviews credentialing or out-of-network denials and follows up with payer to resolve payment
issue or requests a contract.
--- Actively manages payer websites as administrator and assigns logins to assure HIPAA
compliance. Maintains records of all logins assigned and effective dates.
--- Supports the Supervisor Cash Applications with managing and updating payer documents or EDI
forms transitioning payments to ACH and electronic 835s or to bank lockboxes.
--- Enters, modifies, and validates master file data for all insurance payers in the revenue cycle
system. Utilizes technology as available to load validated data electronically.
--- Supports Director by uploading and maintaining payer fee schedules master file data within the
revenue cycle system. Utilizes technology as available to upload validated data electronically.
--- Partners with Revenue Cycle, Sales, or Operations Management on special projects.
--- Remains current with trends, regulatory requirements, and business strategies related to the
payer relations and revenue cycle.
--- Operates in compliance with all local, state and Federal laws as well as policy and compliance
standards.
--- All other duties as assigned.

Requirements

Education and Experience:

--- Bachelor's Degree in healthcare, business, or related field preferred.
--- 3+ years-experience in payer relations, payer contracting, provider enrollment, or credentialing.
--- RHIA or RHIT preferred.

Supervisory Responsibilities:
N/A

Key Job Competencies:

--- Microsoft Office skills - Outlook, Excel, and Word.
--- Expert in professional credentialing, provider enrollment, CAQH Proview, and NPPES I&A
Management Systems.
--- Ability to interpret and apply third party payer credentialing requirements via online or forms.
--- Demonstrated experience auditing and maintaining detailed provider records and payer
contracts.
--- Detail oriented with a high level of organization, analytical, and problem-solving skills.
--- Ability to work autonomously and efficiently within designated timeframes or deadlines in a fast paced environment.
--- Communicates effectively orally and in writing with all levels of the organization.
--- Customer service orientation

Keywords: LifeScan Labs, Skokie , Credentialing Administrator, Other , Skokie, Illinois

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