Job Description

Credentialing Specialist

Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who see it, regardless of insurance status and capability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia and Westchester County. Sun River Health is currently seeking a full-time Credentialing Specialist to join our team at the Peekskill site, remote/hybrid.
The Credentialing Specialist/Payor Enrollment Specialist is responsible for maintenance and enrolling SRH providers into the applicable payors participating including MEDICAID and MEDICARE. We enroll various specialties including; medical, dental, optometry and behavioral health. this function includes supporting the manager of Credentialing/Payor Enrollment and the VP of Information Systems, as well as acting as a liaison with Revenue Cycle, Front Office staff and where necessary additional leadership abilities.

»Maintain the Payor Enrollment database(IntelliCred) and run necessary reports.

»Enter providers data into IntelliCred Software.

»Complete enrollment of new providers' under applicable time constraints

»Complete provider initial enrollment/credentialing and recredentialing with payors.

»Perform all necessary follow-up to ensure timely enrollment and re-enrollment; with reporting processes and meeting with Payer representatives.

»Enroll providers via Delegation, paper application and web-located applications.

»Assist in maintenance ECW concerning new and terminating providers.

»Participate in Revenue Cycle meetings in effort to maintain zero revenue loss and address any provider concerns that effect revenue and patient care.

»She/he will perform other tasks as assigned or requested. In addition, perform job tasks in compliance with systems and job specific standards.

»Work in conjunction with Credentialing/On-Boarding and HR to ensure providers are added and/or updated to systems accurately and timely.

»Updating and Maintenance of monthly Payer Delegation spreadsheets.
Minimum Education Requirement: Associate's Degree
Preferred Education Requirement: Bachelor's Degree
Minimum Related Work practice: 2-4 years
Minimum Specialized expertise & expertise Requirement: capability to communicate in English (oral and written)
Hourly income: $24.73 to $27.47 /Hour

Job Tags

Hourly pay, Full time

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