Credentialing Administrator Addison TX Full Time
From our Dallas corporate headquarters to our clinics and worksite locations, Concentra colleagues remain focused on our driving purpose: to provide superb patient and employer experience by delivering the highest quality healthcare in an efficient, affordable, caring manner. We do this by putting all customers (internal and external) first and by displaying:
- A healing focus
- A selfless heart
- A tireless resolve
Primary responsibilities include, but are not limited to, day-to-day support for the Contracting and Credentialing teams including launching of team workflows in the IntelliCred database; manage and track DOT and APC/ATC certification and compliancy; prepare and submit daily GE report for provider load; routing and tracking of group health payer agreements/contracts for executive review/signatures and weekly follow up with payers for status of counter executed agreements/contracts; allocating and submitting expenses for internal credentialing.
- Register, maintain and track AIM facility, RT licensures/certifications, and system equipment updates on external portal for all radiology services in select markets/states with an Anthem/Amerigroup Medicare Advantage product to ensure compliancy with program requirements for reimbursement of radiology services performed.
- Serve as secondary support for maintaining and tracking DOT certifications for all physicians, nurse practitioners, and physician assistants. Research/validate DOT certification and practice profiles via the National Registry of Certified Medical Examiners (NRCME) website. Notification of DOT certification and practice profile status is communicated to the field EAs and tracked for Concentra compliancy through the IntelliCred database.
- Serve as secondary support for maintaining and tracking all APC/ATC agreements for compliancy. Submits written request to field EAs for APC/ATC agreements for all new hire, annual/biennial renewals and supervising physician changes of Nurse Practitioners, Physician Assistants, and Athletic Trainers. Completion of APC agreement requests are tracked and monitored for compliancy through the IntelliCred database.
- Serve as secondary support for facility credentialing applications for Urgent Care, Physical Therapy and Work Comp payers. Includes completion of simple to complex credentialing applications with supporting documents such as local, state, and federal licensures, CLIA certificates, center assessment and services offered questionnaires. Credentialing activities are maintained and tracked in the IntelliCred database through various workflows.
- Secure needed facility licensures by working with our internal licensing department, clinical and operational leaders.
- Conduct internal audits such as facility rosters and various IntelliCred database validations to ensure data integrity.
- Assist with launching workflows in the IntelliCred system for Medicare, Group Health and Quality Control and Administration teams for new hires, terms, location updates for clinician Medicare enrollment, external payer credentialing needs, APC Collaborative Agreements and DOT certification compliancy.
- Participate in acquisition activities for the department to include but not limited to launching workflows for all teams, updating all internal facility rosters and IntelliCred Group records.
- Prepare various reports such as custom facility listings and provider rosters as requested for internal and external clients.
- Create and maintain Facility Listings on shared drive and Groups/Locations in database to include facility demographics, NPIs, legal entity, TIN, Medicare PTAN and billing information utilized by the department and for external Group Health payer needs.
- Preparation and submission of daily GE report that identifies newly Medicare enrolled and Group Health payer credentialing of clinicians for reimbursement of rendered services.
- Contract comparison reviews to determine any language variances and for accuracy of legal entity, TIN and contracted coverage specifics.
- Route and track contracts for review and signature by executive leaders and conduct payer follow up for status of executed contracts.
- Maintain all Group Health payer contract files via electronic and hard-copy file system.
- Coordinate new employee technical and systems access requests.
- Reconciliation for Internal Credentialing verification charges. Obtain receipts for each transaction, validate and allocate the correct billing string for biweekly submission.
- Other tasks and projects as deemed necessary.
- High school diploma or equivalent
- 2+ years of administrative skills experience
- Advanced Excel skills
- Ability to accurately type.
- Detail oriented and highly organized.
- Ability to utilize all proprietary Concentra software programs.
- Ability to work independently within company guidelines and policies.
- Ability to affectively present information and respond to questions from managers, clients, and customers.
- Ability to speak effectively in one-on-one situations.
- Ability to read and comprehend standardized instructions, short correspondence, and memos.
- Ability to affectively present information in one-on-one situations to other employees, providers, and clients.
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Ability to apply commonsense understanding to carryout instructions furnished in written, oral, or diagram form.
- Basic understand of office equipment (copier, scanner, fax, phone)
- 401(k) with Employer Match
- Medical/Vision/Prescription/Dental Plans
- Life Insurance/Disability
- Paid Time Off/Holidays
- Colleague Referral Bonus Program
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Concentra is an Equal Opportunity Employer, M/F/Disability/Veteran.