Credentialing and Enrollment Specialist at Granville Medical Center – Oxford, North Carolina

MINIMUM QUALIFICATIONS:

Must have completed advanced business school/community college courses or study. 3-5 years of healthcare experience required. Working knowledge of third party payer credentialing/ re-credentialing, enrollment and contracting preferred. Possesses strong organizational and time management skills with attention to detail. Proficient computer skills with experience in Microsoft Excel or Access. Ability to understand and interpret instructions relating to 3rd party payer requirements and scope of work from each payer.

POSITION SUMMARY:

Work encompasses a variety of administrative functions including but not limited to:

· Responsible for timely and accurately submission of Third Party Payer Credentialing packets, enrollment applications and contractual requirements per payer.

· Maintains accurate and up-to-date credentialing matrix defining schedule and status of all applications.

· Maintains various matrix as defined by the Revenue Cycle Director

· Reviews death notices and files appropriate paperwork to protect the Hospital at time of settlement of Estate

· Responsible for the timely and accurate adjustments of all accounts that we have received bankruptcy discharge notices

· Processes all bankruptcy filing notices according to the Hospital policy and procedure

· Maintains various matrix as defined by Revenue Cycle Director

· Co-ordinates 3rd party payer audits with support of the Revenue Cycle Director

· Provides administrative support to the EMS billing and collection company

· Maintains the RAC software for all audited accounts

· Submits registrations for all DDE users

· Calculates the Case Mix index monthly and submits reports

· Maintains confidentiality of position information

· Maintains confidentiality of position information

ACCOUNTABLE TO: Director, Revenue Cycle