Payor Credentialing Specialist at Marion Health – Marion, Indiana

The Payor Credentialing Specialist is responsible for supporting the payor credentialing process, data management, and compliance. Credentialing entails the insurance processing of newly employed medical staff and re-validations of employed health care providers; reviewing insurance credentialing applications for accuracy and completeness; tracking responses, alerting areas of concern; obtaining malpractice insurance verification; initiating and maintaining the CAQH, NPI and PECOS databases for all employed providers as well as completing necessary projects upon request. This specialist will serve as a customer service liaison to managed care organizations, insurance companies and medical providers. Data management and compliance responsibilities include maintaining all provider data collected is accurate and up-to-date. The Specialist may provide assistance with provider support responsibilities, Family Residency Program, Medical Staff Office assignments, provider credentialing and other administrative tasks as assigned. The Payor Credentialing Specialist must maintain the confidentiality of all business/work and medical staff information.

• Associate’s degree in Business Administration, Billing/Coding, Healthcare Administration, or a related field with one (1) year of relevant experience; or
• High school diploma with three (3) years of relevant experience.

• Payor credentialing experience.
• Medical Staff Office experience.

• Excellent communication skills to effectively and tactfully communicate with patients and their families and guests, co-workers, managers, providers and other hospital personnel on a one-to-one basis using appropriate grammar, vocabulary and word usage.
• Interpersonal skills necessary in order to carry out duties in a professional manner, as well as the ability to work well under stress.
• Excellent time management, and organizational skills.
• Ability to problem solve, multi-task in a fast-paced setting and work well in a team environment.
• Developed computer skills to include proficiency with Microsoft Office, telephone system and the ability to learn and proficiently perform computer applications related to department operations and job function.
• Excellent customer service skills.
• High degree of accuracy with concentration and close attention to detail.
• Ability to be discreet and protect the integrity of any confidential matter or information encountered during the performance of job duties.

• Typical office environment with prolonged sitting.
• Work subject to interruption and occasional high stress levels.
• Ability to work occasional extended hours, evenings and/or weekends based on the needs of the department.
• Works with protected health information.

• Use of personal computer and other standard office equipment including but not limited to: telephone, fax, copier, calculator, and scanners.
• Lifting, pushing, pulling, walking sitting, reaching, bending, kneeling or stooping to perform duties in a safe manner.
• Repetitive wrist, finger and hand movement.
• Occasional manipulation of large volumes of books, charts, reports or files.
• Lift supplies or equipment.