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