The Credentialing Administrator is responsible for completing and submitting credentialing applications, enrollment packets, and maintains credentialing status with government and commercial payers. The Administrator ensures in-network status with contracted payers remains active to minimize risk to revenue loss, out-of-network payment reductions or out-of-network authorizations. Additionally, the Administrator organizes and maintains client and payer contract agreements, fee schedules, and credentialing records.
Essential Job Functions:
• Submits initial credentialing applications, enrollment packets, and processes re-credentialing applications timely and accurately to minimize impact on out-of-network payments, revenue loss, and surprise billing.
• Reviews payer mix from clients and compares to Lifescan Labs payer mix. Initiates contracting process for Director.
• Maintains accurate detailed records of all contracting and credentialing work in addition to emails and/or conversations with payers, networks, and government entities.
• Maintains accurate Lifescan Labs profile on Identity Access Management System, CAQH, PECOS, NPPES, and CMS databases.
• Acts as Administrator for the contract management system supporting the Legal, Sales, and Account Management Teams.
• Accurately completes and processes credentialing paperwork or electronic submissions and recertification maintain credentialing status with all payers.
• Ensures contracting, credentialing, and re-credentialing records are accurate. Modifies records as appropriate to maintain accuracy of documents.
• Reviews credentialing or out-of-network denials and follows up with payer to resolve payment issue or requests a contract.
• Actively manages payer websites as administrator and assigns logins to assure HIPAA compliance. Maintains records of all logins assigned and effective dates.
• Supports the Supervisor Cash Applications with managing and updating payer documents or EDI forms transitioning payments to ACH and electronic 835s or to bank lockboxes.
• Enters, modifies, and validates master file data for new clients and all insurance payers in the revenue cycle system. Utilizes technology as available to load validated data electronically.
• Supports Director by uploading and maintaining payer fee schedules master file data within the revenue cycle system. Utilizes technology as available to upload validated data electronically.
• Partners with Revenue Cycle, Sales, or Operations Management on special projects.
• Remains current with trends, regulatory requirements, and business strategies related to the
payer relations and revenue cycle.
• Operates in compliance with all local, state and Federal laws as well as policy and compliance
• All other duties as assigned.Requirements
Education and Experience:
• Bachelor’s Degree in healthcare, business, or related field preferred.
• 3+ years-experience in payer relations, payer contracting, provider enrollment, or credentialing.
• RHIA or RHIT preferred.