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AR Specialist - Credentialing, Medical Staff (9497)

Children's Hospital & Medical Center - Omaha Omaha, NE
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Job Description

When you work at Children’s, you’re part of a treasured place of healing in the Omaha community—and beyond. Join our team of highly engaged, caring professionals who believe deeply in the organization’s mission—to improve the life of every child. We support equity, diversity and inclusion, and as you apply your skills and expertise to helping children, you too will have opportunities to grow your career. In 2021, we’ll open the new Hubbard Center for Children, tripling our capacity to serve children.

When children are your everything, anything can be…

Children's is searching for an AR Specialist- Credentialing who's primary responsibility is to assure that each provider within his/her group practice is credentialed by all participating insurance companies.

Essential Functions/Competencies

% of Time

 

40%

  1. Coordinates the insurance company credentialing process for all the providers that the Physician Billing Department provides billing services for, ensuring completeness and accuracy of information. Initiates required follow up with the applicant, medical staff and physician group leadership, and various medical staff offices to ensure application requirements are met timely and applications are processed within established procedures and timeframes.

40%

  1. Responsible to send the completed application with all required attachments to the insurance company and follow-up with the insurance company to monitor and/or verify the status of the application in a timely fashion. Responsible to maintain the Database (Access and/or Excel) reflecting the current credentialing status of each provider. These databases are to be available to the Lead, Manager, Physician, and any pertinent Physician Billing staff members on a daily basis. Responsible to proactively maintain a notification list for each doctor reflecting expiration dates and notify the proper physician/clinic, in advance, of which physician’s certificate will expire to make sure a new one will be sent to the physician and then forwarded to Physician Billing. If these have expired, the credentialing clerk must contact the proper physician/clinic, medical staff office to acquire a current copy of the certificate.

5%

  1. Responsible to maintain current information on each physician: Demographic information, Curriculum Vitae, Certificate of Insurance (Malpractice), Board and Specialty-Board Certification, State License to Practice Medicine and Surgery and Federal and State Controlled Substance Certificates and any other information deemed necessary by the individual insurance carriers. Responsible to maintain all re-credentialing requests with the same process described in item #1. This normally occurs on a rotating two to three year schedule.

10%

  1. Facilitates special projects, developing processes and performing required follow-up, meeting required deadlines.

 

Regular attendance at work is an essential function of the job.

 

Perform physical requirements as described in the Physical Requirements section

SECONDARY FUNCTIONS/COMPETENCIES

5%

  1. Performs other duties as assigned

100%

 

 
KNOWLEDGE, SKILLS AND ABILITIES:
  • Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations.
  • Ability to communicate effectively both verbally and in writing.
  • Demonstrated skills in data analysis, problem solving and customer service.
  • Demonstrated organizational and time management skills.
  • Proficient oral and written communication and project management skills. Must demonstrate positive interpersonal skills with individuals and groups in a wide variety of settings.
  • Must have the ability to work independently to effectively and efficiently perform assigned duties.  Must be able to effectively communicate with physicians, hospital administrators, billing office staff, insurance carrier representatives, and the public in both verbal and written formats.
  • Accurately type 45 wpm.
  • Basic knowledge of computer systems and Microsoft office (e.g., Word, Excel, etc.)
EDUCATION AND EXPERIENCE:
  • High school diploma or GED required
  • Minimum 1 year experience of healthcare insurance carrier experience required.
  • Minimum 3 years’ experience working with governmental and private insurance carrier’s credentialing requirements including 3 years’ experience with physician billing and insurance company payer requirements and processing payments in a physician billing environment preferred

 

EOE/VETS/DISABLED

Job Details

Date Posted March 25, 2020
Requisition 1322-5852
Address 8200 Dodge St
Located In Omaha, NE
Work At Hospital
Department Medical Staff
Job Type Full-time Employee
Compensation Hourly Wage
Shift
Daytime
Monday - Frida Flexible business hours
Hours 40 hours per week
Positions Available 1
SOC Category 43-9041.00 Insurance Claims and Policy Processing Clerks
Zipcode 68114

This job offers the following benefits

  • 403(b) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • Business Travel Accident Insurance
  • Dental
  • Dependent Life Insurance
  • Employee Assistance Program (EAP)
  • Group Homeowners and Auto
  • Group Legal
  • Life Insurance
  • Long-Term Disability
  • Maternity / Paternity / Family Leave
  • Medical
  • Prescription Drug Plan
  • Short-Term Disability
  • Supplemental Insurance
  • Vision
  • Voluntary Life Insurance
  • Bereavement Pay
  • Cafeteria / Food
  • Continuing Education Program
  • Credit Union
  • Discounts on Employer Merchandise & Services
  • Employee Referral Program
  • Financial Planning
  • Free Parking
  • Health Fair
  • Nursing Facilities
  • Paid Holidays
  • Paid Vacations
  • Tuition Reimbursement
  • Wellness Program
  • Workout Facilities
  • Achievement Awards
  • Bonus Plan
  • Merit Increases

This job requires the following skills

  • Customer Service
  • Insurance Claims Processing - Health
  • Typing
  • Microsoft Office
  • Project Management

This job is related to other jobs in these career categories

Course(s) relevant to the skills listed for this position

At a Glance
Enjoy these benefits
  • 403(b) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • And More ...
Location