Job Description

Credentialing Specialist

Description:

The Credentialing Specialist provides financial, administrative, and clerical support to Credentialing areas of Tryon Management Group. This includes quarterly attestations and payer enrollment functions.



(This is a full-time position based out of the MSO in SouthPark, Monday to Friday 8 am to 5 pm).

Responsibilities:

Monitors tasks within credentialing platform to mitigate any delays and ensure completion from internal stakeholders. Actively reviews and resolves Enrollment dashboard issues within EMR system. Alerts management to unfavorable patterns/trends. Verify participation of all line of business with a payer. Contact payer(s) on claims when an enrollment issue exists. Acts as a point of contact for assigned department(s) for incoming questions regarding third-party billing requirements because of payer enrollment. Analyzes trends in under/overpayments and payment denials and works collaboratively. Keep provider enrollment tables up to date with effective participation/term dates, taxonomy codes, NPI within EHT platform. Completes all internal On/Offboarding tasks for all clinicians. Updates fee schedule in Practice Management system as needed. Maintains allowable schedules in the Practice Management system, as needed. Other duties as assigned.

Requirements:

Education and Certifications:

High school diploma or GED required. High level of proficiency in Microsoft Excel. Ability to work autonomously and as a member of a team, team player with a positive attitude.

Experience:

5+ years in a healthcare related industry All aspects of Payer Credentialing Front office operations Payer follow-up and collections

Physical Requirements:

Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling. Must be able to lift and support weight of 35 pounds. Ability to concentrate on details. Use of computer for long periods of time.


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