Accounts / Receivable Specialist - Credentialing (Central Billing Office)
Location: Omaha Nebraska
Description: Children's Hospital & Medical Center is employing Accounts / Receivable Specialist - Credentialing (Central Billing Office) right now, this position will be placed in Nebraska. More complete informations about this position opportunity kindly see the descriptions. 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%
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 leadership and various medical staff offices to ensure application requirements are met timely and applications are processed within established procedures and timeframes.
3%
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.
35%
Responsible to maintain the Database (Access and/or Excel) reflecting the current credentialing status of each provider. These databases are to be avail! able to the Lead, Manager, Physician, and any pertinent Physic! ian Billing staff members on a daily basis.
5%
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.
2%
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%
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.
5%
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%
Performs other duties as assigned
100%
JOB STANDARDS
Achieves department/organization Outcomes
All
Patient/Customer Satisfaction
Interacts with patients/families/customers and utilizes feedback to improve and reinforce satisfaction
Meets department/organization satisfaction goals
Financial
Identifies and implements systems and processes to improve efficiency and reduce expenses that do not compromise quality of services/mission.
Quality
Meets department/organization quality goals
Dept.
Specific
Patient/Customer Satisfaction
100% of new credentialing achieved within 90 days or prior to provider’s scheduled start date.
100% refund requests processed within 30 days.
100% of internally identified credit balances refunded within 90 days.
Ends all calls with “Is there anything else I can do to assist you?â€
Treat our co-workers with respect and dignity to ensure a positive work environment.
Financial
Reduce non-par write offs to less than 1%.
Quality
Database maintained reflecting real time status of credentialing process.
Takes personal responsibility to adhere to department/organization policies and procedures, compliance and regulatory agency requirements
All
Understands and performs role in! emergency situations (i.e. disruptive individuals, internal/ external disaster, CPR, Code Adam)
Understands and practices regulatory agency standards and department/organization policies/procedures including: Joint Commission, OSHA, HIPAA, Infection Control, Environment of Care, National Patient Safety Goals
Addresses non-compliance with department/organization standards
Meets mandatory department/organization job requirements within established time frames (i.e. physicals, annual mandatory reviews, participates and physically attends 75% of required staff meetings, licensure/certification, CPR for direct care providers)
Dept.
Specific
Remain aware of industry changes and trends and report any policy or procedural requirements to Dept Manager.
Supports a work environment that focuses on staff, customer, patient/families through safe practices and effective communication.
All
Demonstrates and s! upports staff/visitor/patient/vendor identification policy
Uti! lizes variance reporting system to enhance safety and identify changes for best practice
Protects Patient Privacy
Incorporates department/organization communication into work practices
Dept.
Specific
Report all customer problems or issues to Department Manager with a proposed solution.
Demonstrates professional, courteous customer communication with all customers.
BEHAVIORS
Excellence in Service to Children, Families, Colleagues and Other Customers
Anticipates customer needs, understands their expectations and responds appropriately.
Respect for Human Dignity
Treats others with compassion, fairness, courtesy and respect while honoring their uniqueness.
Cooperative Work Relationships
Willingly works with others to identify and achieve common goals.
Positive Attitudes and Behaviors
Enthusiastically approaches their role and displays pride in t! he organization
Honesty and Integrity
Takes personal responsibility for doing the right thing.
Wise Use of Resources
Optimizes the talents of self and others and the use of time, materials and equipment.
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 communicat! e with physicians, hospital administrators, billing office staff, insur! ance 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:
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.
High school diploma or GED required
CERTIFICATIONS/LICENSURE REQUIREMENTS:
SPECIAL REQUIREMENTS:
REQUIRED TRAINING & EMPLOYEE HEALTH REQUIREMENTS
Annual Physical
Annual Mandatory Review
PHYSICAL REQUIREMENTS/WORKING CONDITIONS:
Physical Requirements
N/A
Less than 10%
11% to 49%
Greater than 50%
Work Environment
N/A
Less ! than 10%
11% to 49%
Greater than 50%
Stand
X
Blood and body fluid exposure*
X
Walk
X
Sharps, needles, etc.
X
Sit
X
Wet, humid conditions (non-weather)
X
Talk or hear
X
Work near moving mechanical parts
X
Displays manual dexterity
X
Fumes or airborne particles
X
Climb or balance
X
Toxic or caustic chemicals
X
Stoop, kneel, crouch or crawl
X
Outdoor weather conditions
X
Reach with hands and arms
X
Extreme cold (non-weather)
X
Taste or smell
X
Extreme hot (non-weather)
X
Lifting/pulling/pushing
X
Risk of electrical shock
X
Visual: Looking at computer screen
X
Medical Equip! ment
X
Other:
Risk of radiation
X!
Weight Demands:
Vibration
X
Up to 10 lbs.
X
Loud noise
X
Up to 20 lbs.
X
Quiet environment
X
Up to 40 lbs.
X
Environmental noise
X
Up to 100 lbs.
X
Other:
More than 100 pounds
X
- .
If you were eligible to this position, please email us your resume, with salary requirements and a resume to Children's Hospital & Medical Center.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Tue, 01 Oct 2013 03:05:48 GMT
Apply Accounts / Receivable Specialist - Credentialing (Central Billing Office) Here