Credentialing Specialist- Part Time

Rhode Island Medical Imaging is currently offering a $1,000 sign on bonus! (Prorated on core hours)

SUMMARY:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Consistently applies the corporate values of respect, honesty, fairness and constant pursuit of excellence in improving the health status for the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a diagnostic imaging company.

Ensures that all interactions are in compliance with HIPAA, federal and state compliance regulations.

Responsible for hospital privileging, credentialing and re-credentialing all RIMI physicians, physician’s assistants and fellows.

• Maintains the CAQH database.

• Understands all elements associated with obtaining state medical licenses, Medicare

NPI numbers and all other payor credentials for participation. Keeps current with all insurance changes regarding policy and credentialing guidelines.

• Work closely with medical staff offices, licensing agencies and insurance carriers contacts.

• Ensures insurance companies receive and process credentialing and re-credentialing applications in a timely manner through diligent follow-up.

• Initiates and completes credentialing packets for new providers as soon as notified.

• Keeps a database of all providers’ information and current spreadsheets on statuses.

• Generates an exit packet, i.e. NPI#, malpractice information, etc. for terminating physicians.

Understands all elements associated with completing hospital privileging applications, insurance applications and credentialing software.

Recommends modifications to RIMI’s billing system based on knowledge of credentialing changes.

Maintain MRI/CT volume reports for ACR.

Takes initiative relative to duties, pointing out possible issues or concerns to the Supervisor and/or Manager of Patient Financial Services.

Ability to adapt, in a timely manner, to changes in credentialing rules as defined by insurance companies, hospital staff and/or Management.

Ability to work in a team environment, including cross training co-workers to assist when necessary when directed by the Supervisor, Manager and/or Executive Director of Patient Financial Services.

Maintains a professional manner at all times.

Participates in meetings on an as requested basis.

Performs other duties as assigned.

Performs special projects as assigned by the Supervisor and/or Manager of Patient Financial Services.

REQUIRED KNOWLEDGE:

Excellent telephone and interpersonal skills are essential. Must be able to handle and prioritize work load and work as a team member. Advanced understanding of hospital, governmental and insurance company credentialing requirements and processes.

EXPERIENCE:

High school graduate or equivalent. Three to five years of direct medical credentialing experience required.