Job description

Overview

As a Credentialing Specialist, you will be responsible for proactively completing credentialing and re-credentialing applications on locations that are required for payor contracts, including submitting required licensures, accreditations and W-9s, as well as maintaining timely and accurate rosters for demographic updates and payor notifications, ensuring that Amedisys maintains participation status and accurate demographics with all contracted payors.
Responsibilities

Completes and submits payor credentialing and re-credentialing applications, pulls required regulatory licensures and documents and works closely with the Regulatory, Risk Management, and Clinical Risk Management departments to resolve documentation issues.
Follows-up with payors on status of approval, effective date, and demographic load and notifies the appropriate internal stakeholders of status.
Proactively manages recredentialing renewals to avoid disruption in participation with Health Plan.
Monitors the Data Universal Numbering System Records (DUNs) and Department of Labor (DOL) applications; receives approval status, updates databases accordingly and notifies the appropriate internal stakeholders.
Analyzes care center demographic data through audits to ensure accuracy in the payor systems.
Notifies payor in payor specific format and follows up with payors to ensure timely and accurate system updates, escalates with colleagues when necessary in order to mitigate downstream payment issues
Maintains accurate rosters for each payor, updates/notifies payor and coordinates with internal stakeholders as required
Monitors emails in the Managed Care email box and creates and assigns HelpDesk tickets as appropriate.
Accurately documents credentialing or recredentialing status in required shared database and accurately stores documentation for future reference and/or follow-up.
Qualifications

Required
High school diploma or equivalent.
3 years experience in a medical office, hospital or managed care setting (health plan) contributing to or completing or processing credentialing applications and required documents of providers.
Ability to effectively problem solve, prioritize, and communicate
2-3 years experience with data entry, effectively demonstrating high quality and attention to detail and accuracy. Preferred
Post-secondary education or training in business related field.
Experience in managed care and/or credentialing.
Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

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