Homeoffice Specialist, Credentialing presso Ovation Healthcare

Welcome to Ovation Healthcare!

At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.

The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.

We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.

Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit https://ovationhc.com.

GENERAL SUMMARY:

Credentialing Specialists ensure that medical staff members maintain current credentials and licenses to work legally in their field or specialty. These specialists monitor upcoming renewal dates and work with medical staff to advise them of the required steps to maintain their credentials. They also review information on potential new employees to make sure all required licenses and credentials are current before hiring. Credentialing specialists often work independently. This requires the specialist to be able to manage their workloads effectively to meet set deadlines. Strong computer skills are necessary for the input and maintenance of data, as well as for performing research regarding licensing or credentialing requirements in their area. Interaction with other medical professionals, office personnel, and the public is standard. A Senior Credentialing Specialist will hold 1+ years of seniority working as a Credentialing Specialist II and will be familiar with majority of carrier requirements per state.

DUTIES & RESPONSIBILITIES:

• Monitor credentials and licenses by keeping them up to date with CAQH and all insurance payers that require.

• Complete and submit enrollments with insurance carriers

• Follow up on application status and release claims when complete

• Complete the recredentialing enrollments for providers when necessary

• Maintain communication with insurance carriers on new enrollment processes

• Communicate with clients/providers regarding payer enrollments

• Update and maintain credentialing software and CAQH profiles for credentialing enrollments

• Assist other team members when necessary

• Manage validation lists to ensure payment of claims are made in a timely manner

• Maintain attestations for payer portals as needed

• Update credentialing software and QR Guides to maintain accuracy of data and processes for enrollments

• Work with Payers to resolve claim issues pertaining to provider enrollments

KNOWLEDGE, SKILLS, AND ABILITIES:

• Proficient knowledge of Excel, Word, Outlook, and Teams

• Organizational Skills

• Ability to multi-task

• Strong Communication Skills

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS:

• Provider Payer Enrollments

• Highschool Diploma or GED

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

• 100% Remote

TRAVEL REQUIREMENTS:

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