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McLaren Health Care Credentialing Specialist in Flint, Michigan

Description

Processes and maintains all provider and non-provider

applications for all MMG, subsidiaries and

MSO physicians for all insurance carriers.

Handles billing and revenue cycle inquiries as they relate

to provider enrollment issues. Serves as a liaison between the respective

offices and credentialing department.

  • Responsible for preparing credentialing applications for all carriers.

  • Responsible for obtaining necessary provider information to complete applications.

  • Responsible for setting up provider profiles in practice management system and storing of provider IDs in the computer system.

  • Maintains all group NPI’s and responsible for creating new NPI’s as needed by tax ID and specialty

  • Completes and maintains CAQH records.

  • Maintains Enrollment Worklist and releases claims held for credentialing issues once the issues are resolved or when provider enrolled with payer.

  • Maintains provider credentialing shared drive spreadsheet for all billing staff and management to utilize.

  • Produces reports for management staff to help identify and resolve credentialing issues.

  • Maintains and distributes weekly Physician Insurance Summary Report

  • Maintains and updates insurance credentialing information through attending seminars, keeping manuals current, and keeping current mailings on file.

  • Assists managers with training and educating employees on the credentialing process.

  • Serves as a liaison between credentialing, office staff, providers and carriers.

  • Performs related duties, as required.

Qualifications

Required:

  • High

School diploma and related courses.

  • Minimum

2 years experience of physician billing and/or credentialing process.

  • Extensive

knowledge of CAQH System, NPPES, BCBSM EDI TPA online application, CHAMPS, CMS

and PECOS

  • Must

have knowledge of all third party carriers application and claims processing

guidelines as it relates to PIN info.

  • Must

be able to communicate professionally with all providers, CEO’s VP’s and

Directors of all MHCC entities.

Preferred:

  • Experience

with Microsoft Office.

  • 1-2

years within Physician Billing Department

Equal Opportunity Employer ofMinorities/Females/Disabled/Veterans

Job: Administrative/Clerical

Primary Location: Michigan-Flint-Corporate Srvcs Building-MMG

Job Type Standard

Req ID: 21002965

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