JOB DETAILS

CREDENTIALING SPECIALIST

Job Title:Credentialing Specialist

Reports To: Revenue Cycle Manager

FLSA Status: Non-Exempt

Department: Finance

About Boston Orthotics & Prosthetics: As a leader in specialized pediatric orthotics, we take great pride in having the industry's top clinicians, technicians, and

administrative staff, led by an executive team dedicated to advancing the orthotics and prosthetics profession.

Boston O&P Vision:To be recognized as the premier provider of pediatric orthotic and prosthetic services and products in the United States.  

Core Values: Boston O&P embraces lean culture, demonstrated by our core values:

Truth and Transparency
Accountability
Standardization of Process
Engagement and Commitment
Contribution to Sales Growth and Education

Our team believes in respectful truth and transparency when interacting with patients, referral sources, and our own team members. We hold ourselves accountable to provide only the best products and services to our patients. Our team is engaged and committed to continuous improvement of our products, our patient care, and ourselves.

Position Description: The Contracts and Credentialing Specialist is responsible for the timely enrollment of new payors and on-going maintenance of existing payors. This role requires a desire to develop and follow process, strong attention to detail and excellent communication skills (written and verbal) to convey information topayors and cross functionally within the organization.

Core Responsibilities:

Prepare credentialing and re-credentialing applications on behalf of BOP clinics and providers for submission to payor contracting entity.
Accurately perform review of new enrollment files for deficiencies and perform follow up on delinquencies.
Responsible for the on-going maintenance of existing BOP locations/clinics and providers including but not limited to the submission of maintenance update forms, weekly expirables and tracking of licenses, certifications and surety bonds
Research and solve credentialing/re-credentialing delays & issues with contracting entity in a timely manner.

Maintains Provider Enrollments: Prepares BOP clinic and provider applications, staff rosters, re-enrollment, and terminations forms and submits them to 3rd party insurance plans.
Works with Clinics and Providers: Communicates enrollment requirements, completes applications, verifies information, and obtains signatures.
Maintains credentialing, enrollment and web portal access tasks in billing system
Maintains insurance web portal access, adding/removing users as needed.
Maintains Data: Enters and updates clinic and provider information in billing system, and department databases.
Follows Timely Processes: Produces status reports and tracking spreadsheets.
Coordinates with Managers: Clarifies provider start dates, practice locations, specialty areas, privileges, and enrollment status.
Prepares and submits facility/clinic and provider applications to 3rd party insurance plans, Medicaid and Medicare
Ensure that all information meets federal and state guidelines when processing applications.
Keep a facility's/clinic and provider accreditation up to date and assist with audits.
Compiles and maintains current and accurate data for all clinics and providers
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all clinics and providers.
Opens incoming mail and distributes accordingly
Accesses confidential and secure federal, state and private databases as need to complete assignments
Triage billing calls and sends messages to appropriate CBO member for completion.
Posts insurance and patient refunds (via check) into billing system

Education/Experience:

Three - five years’ experience in credentialing or healthcare preferred.
Excellent interpersonal skills, including the ability to communicate written and verbally with individuals at all levels in a clear, succinct manner.
Understanding of Medicare and Medicaid reimbursement methodologies and community health reimbursement health care services and contracting methodology.

Knowledge of ICD-10 how E&M coding translates into CPT codes desired.
Results driven, able to self-direct and work independently as well as perform in a team environment.
Ability to multi-task, organized, pay close attention to details and be flexible in a fast-paced organization.

*This job description is not intended to be and should not be construed as an all- inclusive list of all the responsibilities and working conditions of the position. While it is intended to accurately reflect the position activities and requirements, management reserves the right to modify, add or remove duties and assign other duties as necessary.

Equal Opportunity Employer

Boston O&P is proud in its commitment to creating a diverse workforce and providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, parental status, national origin, age, disability, citizenship status, genetic information or characteristics, marital status, status as a Vietnam era veteran, special disabled veteran, or other protected veteran in accordance with applicable federal, state and local laws, and any other characteristic protected by law.

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