Credentialing Administrator

Company: LifeScan Labs
Location: Skokie
Posted on: May 16, 2022

Job Description:

Position Summary:
The Credentialing Administrator is responsible for completing and submitting credentialingapplications, enrollment packets, and maintains credentialing status with government andcommercial payers. The Administrator ensures in-network status with contracted payers remainsactive to minimize risk to revenue loss, out-of-network payment reductions or authorizations.Organizes and maintains payer contract agreements, fee schedules, and credentialing records bypayer for Lifescan Labs.
Essential Job Functions: --- Submits initial credentialing applications, enrollment packets, and processes re-credentialingapplications 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 contractingprocess for Director.--- Maintains accurate detailed records of all contracting and credentialing work in addition to emailsand/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 maintaincredentialing status with all payers.--- Ensures contracting, credentialing, and re-credentialing records are accurate. Modifies records asappropriate to maintain accuracy of documents.--- Reviews credentialing or out-of-network denials and follows up with payer to resolve paymentissue or requests a contract.--- Actively manages payer websites as administrator and assigns logins to assure HIPAAcompliance. Maintains records of all logins assigned and effective dates.--- Supports the Supervisor Cash Applications with managing and updating payer documents or EDIforms 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 cyclesystem. Utilizes technology as available to load validated data electronically.--- Supports Director by uploading and maintaining payer fee schedules master file data within therevenue 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 thepayer relations and revenue cycle.--- Operates in compliance with all local, state and Federal laws as well as policy and compliancestandards.--- 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&AManagement Systems.--- Ability to interpret and apply third party payer credentialing requirements via online or forms.--- Demonstrated experience auditing and maintaining detailed provider records and payercontracts.--- 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