Credentialing Specialist (Washington, DC)

Unity Health Care | Washington, DC

Job Description

Department: Quality Improvement

Schedule: Full Time

Shift: Days

Hours: 7.5

Job Details

Under the supervision of the Coding Manager, the Credentialing Specialist is primarily responsible Administers Credentialing process via network. Works independently to coordinate, develop, monitor and maintain the credentialing process. The Credentialing Specialist coordinates provider relationships with Medicaid HMOs and other private insurance companies to increase third party revenue.  Also, performs necessary tracking results and reconciliation for capitation payments and provider credentialing.

QUALIFICATIONS

  • Bachelor’s degree preferred or at least three to five years’ experience
  • Requires Experience with database reporting and proficiency with word processing and spreadsheet software.
  • Past experience required in this or similar role for a minimum of 3 years as well as effective verbal and written communication skills to communicate with providers, Manage Care Companies, and hospital personnel via phone, email and through prepared correspondence.
  • At least three years of experience with the EMR or other FQHC system.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

  • Minimum five years of healthcare insurance experience to include Medicaid (District of Columbia & Maryland), Medicare, HMOs, and private insurance.
  • Creativity, flexibility, and vision-oriented.
  • Ability to work independently in a team oriented environment and interact well with individuals with diverse ethnic and cultural backgrounds and needs.
  • Superior oral and written communication skills.
  • History of positive customer relations as demonstrated by supervisor recommendation.
  • Ability to perform presentations and interact with many different levels of UHC leadership.
  • Familiar with medical billing and collection procedures to include Medicaid, Medicare, private insurance, and self-pay.
  • Working knowledge of eCW or other patient management systems.
  • Ability to work independently with minimum supervision.
  • Excellent computer skills, including Excel, Microsoft Word, etc.

To apply please view the listing at Unity Health Care.