Job Details
Usa Insurance, Credentialing Specialist, Secretary And Claims Follow Up.
Posted: 03/26/2020
Position: Full Time
About This Job:
Responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process for our clients. Facilitates all aspects of credentialing, including initial
appointment, reappointment, expirable process, as well as clinical privileging for Medical Staff,
Allied Health Professionals, and all other providers outlined in the policies or related contracts.
Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies,
while developing and maintaining a working knowledge of the statues and laws relating to
credentialing. Responsible for the accuracy and integrity of the credentialing database system and
related applications. Works under the supervision of the Credentialing Manager.
Roles & Responsibilities:
1. Answer telephones
2. Manage projects, and contribute to committee and team work.
3. Leads, coordinates, and monitors the review and analysis of practitioner applications and
accompanying documents, ensuring applicant eligibility.
4. Conducts thorough background investigation, research and primary source verification of all
components of the application file.
5. Identifies issues that require additional investigation and evaluation, validates discrepancies and
ensures appropriate follow up.
6. Prepares credentials file for completion and presentation to insurances, ensuring file completion
within time periods specified.
7. Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege
8. Responds to inquiries from other healthcare organizations, interfaces with internal and external
customers on day-to-day credentialing and privileging issues as they arise.
9. Assists with managed care delegated credentialing audits; conducts internal file audits.
10. Utilizes Google Drive as a credentialing guidelines and Asana a credentialing database to
optimize efficiency, and performs follow up and status report.
11. Monitors the initial, reappointment and expirables process for all engaged clients/providers.
12. Performs miscellaneous job-related duties as assigned.
13. Create Quotes for services
14. Bill provider for services
15. Collects payment from clients
16. Enter invoices and payments in QuickBooks
17. Update Google Drive to follow up on engaged assignments
18. Log all call and status in Asana.
Requirements & Qualifications:
 Ability to communicate effectively, both orally and in writing.
 Very detailed oriented and attention to details.
 Program planning and implementation skills.
 Ability to analyze, interpret and draw inferences from research findings, and prepare status
 Informational research skills.
 Ability to use independent judgment to manage and impart confidential information.
 Database management skills including querying, reporting, and document generation.
 Ability to make administrative/procedural decisions and judgments.
Not experience needed, if meet the above skills.
Skills Required:
Administrative Support
Typing Level 5
Virtual Assistant Level 4
Office Admin Level 4
Admin Assistant Level 4
Medical Billing Level 1
Customer Service
Email Support Level 5
Phone Support Level 5
Customer Support Level 5